Clinico-epidemiological profile and risk factors associated with failure of conservative therapy in pediatric empyema patients

Abstract

Objective: The objective is to study the clinico-epidemiological profile and risk factors associated with failure of conservative therapy in pediatric empyema patients and to correlate the Light’s criteria in the same. Materials and Methods: A hospital-based prospective observational study was performed in the pediatric department of a tertiary care hospital, New Delhi. A total of 74 children of ?12 years of age having either macroscopic frank pus in pleural tap or a positive Gram-stain or positive culture in pleural fluid were enrolled in the study. Those empyema patients who fail to improve with antibiotics and chest tube drainage after 7–14 days (4 weeks for Staphylococcus aureus and 6–12 weeks for anaerobic organisms, respectively) or develop some complications in the mean time were considered as a failure of therapy. Results: Head nodding, lethargy and inability to feed/drink, prior antibiotic therapy, duration of illness (>7 days) before presenting to the hospital, and growth on the cultures were the main factors associated with the failure of conservative therapy. S. aureus is the most common organism causing empyema. Considering Light’s criteria, significant results were obtained and almost all the enrolled empyema patients found to have exudative pleural fluid. In the study, failure of conservative therapy occurred in 27.03%, prolonged hospitalization was seen among 48.65 % children, 28.38% needed change in antibiotics, and 1.35% children expired. Conclusion: History of prior antibiotic therapy, long duration of illness, and clinical features at admission along with the microorganism involved affect the conservative therapy response and may predispose to complications. Light’s criteria were very well validated in the study for its use in pediatric population.