Abstract:
Introduction: Pleural empyema in children is associated with high morbidity and high
mortality. Staphylococcus aureus has been shown to be the most common causative
organism in developing countries.
Study design: This study applied a retrospective quantitative descriptive study
design.
Study population: The population of the study is comprised of children (between 1
years and 13 years) admitted to Pietersburg Provincial Hospital with pleural
empyema from January 2016 until December 2020.
Objectives: The study aimed to determine the causative organisms of pleural
empyema, the treatment outcomes, and the relationship between pleural empyema,
TB, and HIV infection.
Data collection: The National Health Laboratory Services database was used to
identify patients who had pleural empyema. A self-generated data collection tool was
used to obtain secondary data related to all patients who met the operational definition
of pleural empyema during the defined time period.
Results: Eleven participants met inclusion criteria. The mean age of participants was
42 months with 43.8 standard deviation and 64% were males and females were 36%
. Of these participants, 40% cultured S. Aureus in the pleural fluid, 10% Streptococcus
pneumoniae, 30% were sterile and 20% cultured other organisms such as Klebsiella
pneumoniae and Haemophilus influenzae. Cloxacillin was the most prescribed
antibiotic. Intercostal drainage was inserted in 91% of the participants of which 18%
were successful, no further surgical intervention needed,73% had thoracotomy and
VATS was offered to 91% of participants and it was followed by thoracotomy.
Fibrinolytics were not offered to the participants in this study. The majority of patients,
55%, were discharged back to their peripheral hospitals and 27% of them died. PCV
immunisation status of the children was not documented hence the relationship
between pleural empyema and PCV immunisation could not be established. There
was a positive correlation between age of patients with pleural empyema and ICU
length of stay (r=89%; p=0,01) while another strong correlation was depicted between
HIV status and hospital length of stay (r=88%, p=0,019). Results further show a
positive association between outcome and surgery intervention offered (Chi=7,00;
p=0,02).
Conclusion: Our study showed that S. aureus is the leading cause of pleural
empyema, with a predominance of thoracocentesis and thoracotomy offered as
surgical interventions.
