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Article

Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

by
Patrick M. Meyer Sauteur
1,2,†,
Ariane Burkhard
1,2,†,
Ueli Moehrlen
2,3,
Christa Relly
1,2,
Christian Kellenberger
2,4,
Kerstin Ruoss
2,5 and
Christoph Berger
1,2,*
1
Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
2
Children’s Research Center, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
3
Department of Pediatric Surgery, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
4
Division of Radiology, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
5
Emergency Department, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(5), 698; https://doi.org/10.3390/jcm8050698
Submission received: 15 April 2019 / Revised: 1 May 2019 / Accepted: 8 May 2019 / Published: 16 May 2019
(This article belongs to the Special Issue Diagnosis and Treatment of Pneumonia)
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Abstract

Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.
Keywords: antibiotics; community-acquired pneumonia; chest tube; drainage; fibrinolysis; parapneumonic effusion; pleural draining catheter; pleural tap; Streptococcus pneumoniae; thoracocentesis; thoracotomy; video-assisted thoracic surgery antibiotics; community-acquired pneumonia; chest tube; drainage; fibrinolysis; parapneumonic effusion; pleural draining catheter; pleural tap; Streptococcus pneumoniae; thoracocentesis; thoracotomy; video-assisted thoracic surgery
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MDPI and ACS Style

Meyer Sauteur, P.M.; Burkhard, A.; Moehrlen, U.; Relly, C.; Kellenberger, C.; Ruoss, K.; Berger, C. Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. J. Clin. Med. 2019, 8, 698. https://doi.org/10.3390/jcm8050698

AMA Style

Meyer Sauteur PM, Burkhard A, Moehrlen U, Relly C, Kellenberger C, Ruoss K, Berger C. Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. Journal of Clinical Medicine. 2019; 8(5):698. https://doi.org/10.3390/jcm8050698

Chicago/Turabian Style

Meyer Sauteur, Patrick M., Ariane Burkhard, Ueli Moehrlen, Christa Relly, Christian Kellenberger, Kerstin Ruoss, and Christoph Berger. 2019. "Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study" Journal of Clinical Medicine 8, no. 5: 698. https://doi.org/10.3390/jcm8050698

APA Style

Meyer Sauteur, P. M., Burkhard, A., Moehrlen, U., Relly, C., Kellenberger, C., Ruoss, K., & Berger, C. (2019). Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. Journal of Clinical Medicine, 8(5), 698. https://doi.org/10.3390/jcm8050698

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