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1.
Vaccine ; 37(20): 2704-2711, 2019 05 06.
Article in English | MEDLINE | ID: mdl-30981627

ABSTRACT

Etiology and serotyping of parapneumonic effusion (PPE) and the impact of vaccination was evaluated over a 12-year period, before and after the PCV13 introduction (2011) for Italian children From 0 to 16 years of age. Five hundred and two children were evaluated; 226 blood and 356 pleural fluid samples were obtained and tested using Realtime-PCR and culture. In the pre-PCV13 era S. pneumoniae was the most frequent pathogen identified (64/90; 71.1%) with a large predominance of serotypes 1 (42.4%), 3 (23.7%), 7F (5.1%) and 19A (11.9%). The impact of vaccination, calculated on children 0-8 years of age, demonstrated a significant reduction of PPE: with an incidence rate of 2.82 (95%CL 2.32-3.41) in the pre-PCV13 era and an age-standardized rate (ASR) of 0.66 (95% CL 0.37-1.99) in the post-PCV13 era, p < 0.0001. No increase in non-PCV13 serotypes was recorded. S. pneumoniae remained the most frequent pathogen identified in the post-PCV13 era in unvaccinated children with an unchanged serotype distribution: respectively 26/66 (39.4%), 25/66 (37.9%), 5/66 (7.6%), and 4/66 (6.1%) for 1, 3, 7F and 19A. On the other hand 7F and 19A disappeared in vaccinated children and serotype 1 and 3 decreased by 91.8% and 31.5%, respectively. Realtime PCR was significantly more sensitive than culture both in pleural fluid (79.7% vs 12.5%) and in blood (17.8% vs 7.4%). In conclusion, our findings indicate that routine immunization with PCV13 has significantly reduced the burden of childhood PPE in vaccinated children, without increasing PPE due to other bacteria and without serotype shift. Moreover, the impact of PCV13 may be underestimated due to the increase in pneumococcal surveillance in Italy. Data has also shown that Real-time PCR is an essential tool to better define the etiology of PPE and to monitor vaccination plans. Longer studies will be necessary to evaluate the role of herd protection in PPE prevention.


Subject(s)
Pleural Effusion/prevention & control , Pneumococcal Vaccines/immunology , Pneumonia, Pneumococcal/prevention & control , Streptococcus pneumoniae/immunology , Vaccines, Conjugate/immunology , Child , Child, Preschool , Empyema, Pleural/epidemiology , Empyema, Pleural/etiology , Empyema, Pleural/prevention & control , Female , History, 21st Century , Humans , Incidence , Italy/epidemiology , Male , Pleural Effusion/epidemiology , Pleural Effusion/etiology , Pleural Effusion/history , Pneumococcal Vaccines/administration & dosage , Pneumonia, Pneumococcal/complications , Pneumonia, Pneumococcal/epidemiology , Pneumonia, Pneumococcal/history , Public Health Surveillance , Serogroup , Streptococcus pneumoniae/classification , Vaccination , Vaccines, Conjugate/administration & dosage
2.
Folia Med (Plovdiv) ; 61(3): 352-357, 2019 Sep 30.
Article in English | MEDLINE | ID: mdl-32337920

ABSTRACT

BACKGROUND: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge. MATERIALS AND METHODS: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention. RESULTS: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications. CONCLUSION: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications.


Subject(s)
Empyema, Pleural/epidemiology , Pneumonectomy/adverse effects , Postoperative Complications/epidemiology , Empyema, Pleural/etiology , Empyema, Pleural/prevention & control , Humans , Surgical Flaps , Sutures
3.
Thorac Surg Clin ; 28(3): 323-335, 2018 Aug.
Article in English | MEDLINE | ID: mdl-30054070

ABSTRACT

Development of postpneumonectomy empyema with bronchopleural fistula is a life-threatening condition that requires prompt action. Although measures should be taken to prevent bronchopleural fistula at time of pneumonectomy, many patients experience this complication. Management focuses on drainage of the pleural space, control of the pleural infection including repair of the bronchopleural fistula, and obliteration of the residual pleural cavity. Multiple techniques and procedures have been developed over time to achieve these goals. Knowledge of the diverse therapeutic options is important to select the optimal treatment for these complex patients.


Subject(s)
Bronchi/surgery , Bronchial Fistula/surgery , Empyema, Pleural/therapy , Pleural Diseases/surgery , Pneumonectomy/adverse effects , Sternum/surgery , Thoracoplasty , Bronchial Fistula/etiology , Bronchial Fistula/prevention & control , Bronchial Fistula/therapy , Empyema, Pleural/etiology , Empyema, Pleural/prevention & control , Empyema, Pleural/surgery , Humans , Pleural Diseases/etiology , Pleural Diseases/prevention & control , Pleural Diseases/therapy , Thoracic Surgical Procedures/methods , Thoracoplasty/adverse effects
4.
J Pediatric Infect Dis Soc ; 7(1): 30-35, 2018 Feb 19.
Article in English | MEDLINE | ID: mdl-28339727

ABSTRACT

BACKGROUND: In January 2012, Argentina included universal pneumococcal vaccination in the routine childhood vaccination program using a 13-valent pneumococcal conjugate vaccine (PCV13). A 2 + 1 schedule (2 doses in the first year of life and a booster dose at 12 months of age) in children aged <2 years and 2-dose catch-up immunization in children aged 13 to 24 months was administered during the first year of vaccine introduction. The purpose of this study was to assess the burdens of invasive pneumococcal disease (IPD) and/or community-acquired pneumonia (CAP) in hospitalized children younger than 5 years during the first 2 years of the program compared to those in the prevaccination period in our setting. METHODS: This was a multicenter, prospective, and descriptive study. Rates of hospitalization resulting from IPD and/or CAP in 5 pediatric reference centers across the country were analyzed (every 10 000 admissions). Clinical, epidemiologic, and microbiological data were recorded. Statistical analysis using Stata 8.0 was performed. RESULTS: A comparison of rates of hospitalization resulting from global IPD and/or CAP in the prevaccine (2009-2011) and postvaccine (2012-2013) periods revealed significant decreases of 50% (P = .003) and 51% (P < .0001), respectively. Significant decreases were also observed in number of hospitalizations resulting from empyema (39%; P = .03) and pneumococcal empyema (67.8%; P = .007); the reduction was not statistically significant for pneumococcal CAP (58%; P = .18). Hospital stays for IPD and/or CAP decreased by 56%. CONCLUSION: Rapid and significant decreases in the rates of hospitalization resulting from IPD and/or CAP during the first 2 years after PCV13 introduction were observed. A longer surveillance period is required to confirm these results and the effectiveness of the vaccination program.


Subject(s)
Hospitalization/statistics & numerical data , Pneumococcal Vaccines/therapeutic use , Pneumonia, Pneumococcal/epidemiology , Argentina/epidemiology , Child, Preschool , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/prevention & control , Empyema, Pleural/epidemiology , Empyema, Pleural/prevention & control , Female , Humans , Infant , Infant, Newborn , Male , Pneumonia, Pneumococcal/prevention & control
6.
Chirurg ; 86(5): 432-6, 2015 May.
Article in German | MEDLINE | ID: mdl-25920472

ABSTRACT

BACKGROUND: Persistent postoperative pleural effusion can occur after thoracic surgery and might lead to progressive dyspnea with a subsequent complicated and prolonged hospital stay. OBJECTIVES: The etiology, prevention and therapy of persistent pleural effusion after thoracic surgical interventions are presented. MATERIAL AND METHODS: A selective literature search was carried out in Medline (pleural effusion, pleural empyema and chylothorax). RESULTS: Persistent pleural effusions were observed especially after lung resection due to disorders in the pleural fluid balance and reduced postoperative lung expansion. An adequate chest tube management and postoperative physical therapy can reduce the incidence of postoperative pleural effusion. Relevant postoperative bleeding causes a hemothorax. An infection of the pleural effusion is defined as pleural empyema. These patients suffer from a significantly higher postoperative morbidity and require an adjusted multimodal treatment. Intraoperative injury of the thoracic duct can result in a postoperative chylothorax, which should be diagnosed early with specific laboratory investigations of the milky fluid. Interventional radiological procedures have now taken their place alongside conservative measures and surgical procedures in the therapy of chylothorax. CONCLUSION: Persistent postoperative pleural effusion after thoracic surgical interventions warrant early diagnosis and an adjusted treatment in order to avoid further complications and to shorten the postoperative hospital stay.


Subject(s)
Pleural Effusion/etiology , Postoperative Complications/etiology , Thoracic Surgical Procedures/adverse effects , Chylothorax/etiology , Chylothorax/prevention & control , Chylothorax/therapy , Dyspnea/etiology , Dyspnea/prevention & control , Dyspnea/therapy , Early Diagnosis , Early Medical Intervention , Empyema, Pleural/etiology , Empyema, Pleural/prevention & control , Empyema, Pleural/therapy , Humans , Length of Stay , Pleural Effusion/prevention & control , Pleural Effusion/therapy , Pneumonectomy/adverse effects , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Thoracic Duct/injuries
8.
J Trauma Acute Care Surg ; 73(5 Suppl 4): S341-4, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23114491

ABSTRACT

BACKGROUND: Antibiotic use in injured patients requiring tube thoracostomy (TT) to reduce the incidence of empyema and pneumonia remains a controversial practice. In 1998, the Eastern Association for the Surgery of Trauma (EAST) developed and published practice management guidelines for the use of presumptive antibiotics in TT for patients who sustained a traumatic hemopneumothorax. The Practice Management Guidelines Committee of EAST has updated the 1998 guidelines to reflect current literature and practice. METHODS: A systematic literature review was performed to include prospective and retrospective studies from 1997 to 2011, excluding those studies published in the previous guideline. Case reports, letters to the editor, and review articles were excluded. Ten acute care surgeons and one statistician/epidemiologist reviewed the articles under consideration, and the EAST primer was used to grade the evidence. RESULTS: Of the 98 articles identified, seven were selected as meeting criteria for review. Two questions regarding presumptive antibiotic use in TT for traumatic hemopneumothorax were addressed: (1) Do presumptive antibiotics reduce the incidence of empyema or pneumonia? And if true, (2) What is the optimal duration of antibiotic prophylaxis? CONCLUSION: Routine presumptive antibiotic use to reduce the incidence of empyema and pneumonia in TT for traumatic hemopneumothorax is controversial; however, there is insufficient published evidence to support any recommendation either for or against this practice.


Subject(s)
Antibiotic Prophylaxis/standards , Chest Tubes/standards , Hemopneumothorax/surgery , Thoracic Injuries/surgery , Thoracostomy/standards , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis/methods , Empyema, Pleural/prevention & control , Hemopneumothorax/drug therapy , Hemopneumothorax/etiology , Humans , Pneumonia/prevention & control , Thoracic Injuries/complications , Thoracic Injuries/drug therapy , Thoracostomy/methods
9.
Zentralbl Chir ; 137(3): 223-7, 2012 Jun.
Article in German | MEDLINE | ID: mdl-22711321

ABSTRACT

In order to achieve respectable postoperative outcomes after lung resection it is essential to understand the mechanism of bronchus healing. The bronchus seal should be air-tight and consist of monofilament suture or staples. The bronchus suture should be covered with vital tissue (lung, mediastinum, muscle flap). A complication in the process of bronchus healing should be diagnosed as early as possible in order to stop the destructive effect of the infection as rapidly as possible.


Subject(s)
Anastomosis, Surgical/methods , Anastomotic Leak/prevention & control , Anastomotic Leak/surgery , Bronchi/surgery , Bronchial Fistula/prevention & control , Bronchial Fistula/surgery , Empyema, Pleural/prevention & control , Empyema, Pleural/surgery , Fistula/prevention & control , Fistula/surgery , Lung Neoplasms/surgery , Pleural Diseases/prevention & control , Pleural Diseases/surgery , Pneumonectomy , Bronchoscopy , Chest Tubes , Humans , Surgical Stapling , Suture Techniques , Wound Healing/physiology
10.
Semin Thorac Cardiovasc Surg ; 24(1): 37-41, 2012.
Article in English | MEDLINE | ID: mdl-22643660

ABSTRACT

Pleural space problems can create formidable treatment dilemmas for thoracic surgeons. Most arise as iatrogenic sequelae of lung resections, although some occur as late consequences of infection, hemothorax, or systemic inflammatory disease. Regardless of etiology, a central theme in the development and perpetuation of chronic pleural space problems is that there has been a loss of parietal-visceral pleural apposition, and this has allowed for development of an obligate space. A variety of surgical strategies aimed at reestablishment of pleural apposition and obliteration of pleural space are reviewed.


Subject(s)
Lung Diseases/surgery , Pleura/surgery , Thoracic Surgical Procedures/methods , Absorbable Implants , Anastomotic Leak/etiology , Anastomotic Leak/prevention & control , Empyema, Pleural/etiology , Empyema, Pleural/prevention & control , Humans , Pneumoperitoneum, Artificial/methods , Thoracic Surgical Procedures/adverse effects , Tuberculosis, Pulmonary/etiology , Tuberculosis, Pulmonary/surgery
11.
Rev Med Chir Soc Med Nat Iasi ; 116(4): 1157-61, 2012.
Article in English | MEDLINE | ID: mdl-23700905

ABSTRACT

UNLABELLED: The aim of the paper is to observe the effectiveness of prophylactic administration of antibacterials against empyema and pneumonia after tube thoracostomy for traumatic collections. MATERIAL AND METHODS: Observational retrospective study over a ten years period (2002-2011), at the Oradea County Emergency Hospital on 939 patients with chest tube drainage for traumatic haemo/pneumothoraces. The morbidity by intrathoracic infections was 5,5% in the curative antibiotic group. RESULTS: The median number of risk factors for surgical infections and case severity were not statistically different (p=0.9653 and p=0,6601) between cases with antibioprophylaxis and curative treatment, but the incidence of intrathoracic infection in the prophylaxis group (n=86) was half (2,3%). Antibioprophylaxis was effective in over 95% of the cases and it associated in-hospital length of stay, length of stay in the ICU and costs of care significantly (p<0.0001, p<0.0001, p=0.0046) lesser than of those patients treated with curative regimen. The overall mortality was 8.6% within the curative regimen group with an attributable mortality to infections of 17.39%; but it was only 2.3% and respectively 0 within the prophylaxis group. CONCLUSIONS: Antibiotic prophylaxis for intrathoracic infections after tube thoracostomy for traumatic collections was justified by case severity and risk factors and was effective and cost-efficient, but it should be administered selectively.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Empyema, Pleural/prevention & control , Hemopneumothorax/drug therapy , Hemopneumothorax/surgery , Pneumonia, Bacterial/prevention & control , Thoracic Injuries/surgery , Thoracostomy , Chest Tubes/adverse effects , Emergency Service, Hospital , Empyema, Pleural/mortality , Hemopneumothorax/etiology , Hospitals, County , Humans , Incidence , Length of Stay , Pneumonia, Bacterial/mortality , Retrospective Studies , Risk Factors , Romania/epidemiology , Thoracic Injuries/complications , Thoracostomy/adverse effects , Treatment Outcome
12.
Acta Paediatr ; 100(9): 1230-3, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21443529

ABSTRACT

BACKGROUND: During the past two decades, the incidence of paediatric empyema has increased in many countries. PURPOSE: The aim of this retrospective hospital chart review was to evaluate the incidence, aetiology and clinical and laboratory characteristics of parapneumonic empyema in children. SUBJECTS AND METHODS: Twenty-one patients were admitted to a university hospital from the area with a population of 84,000 children in 1991-2009. RESULTS: The annual incidence of parapneumonic empyema was 1.6/100,000 children in 1991-1998, 0.2/100,000 children in 1999-2005 and 2.7/100,000 children in 2006-2009. Bacterial aetiology was identified in 52% of the cases, and pneumococcus caused 45% of the cases with bacterial aetiology detected. The clinical and laboratory findings in children with and without pleural effusion on admission were surprisingly similar. The development of empyema in hospital during antibiotic therapy was associated with persistent fever and serum C-reactive protein (CRP) >200 mg/L for 48 h after admission. CONCLUSION: The incidence of parapneumonic empyema in children fluctuated but in the long run, increased in 1991-2009. Pneumococcus caused half of the cases with bacterial diagnosis available. Since 2010, pneumococcal vaccination has belonged to the general vaccination programme, and the effect on the incidence of empyema remains to be seen.


Subject(s)
Empyema, Pleural/epidemiology , Empyema, Pleural/prevention & control , Pneumococcal Vaccines/administration & dosage , Adolescent , C-Reactive Protein , Child , Child Welfare/trends , Child, Preschool , Empyema, Pleural/microbiology , Female , Hospitals, University/statistics & numerical data , Humans , Incidence , Infant , Length of Stay , Male , Retrospective Studies , Statistics, Nonparametric , United States/epidemiology
14.
Thorax ; 65(9): 770-4, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20805169

ABSTRACT

BACKGROUND: Childhood bacterial pneumonia and empyema rates have reportedly increased in recent years in Europe. In September 2006 the seven-valent pneumococcal conjugate vaccination (PCV7) was introduced to the childhood national immunisation programme in England following a successful PCV7 campaign in the USA. The aim of this study was to report national time trends in hospital admissions for childhood bacterial pneumonia and empyema in England before and after the introduction of PCV7. METHODS: A population-based time-trend analysis of Hospital Episode Statistics data of children aged <15 years admitted to all NHS hospitals in England, with a primary diagnosis of bacterial pneumonia and empyema from 1997 to 2008 was performed. Annual crude and age-sex standardised hospital admission rates for bacterial pneumonia and empyema were calculated. RESULTS: Admission rates for bacterial pneumonia and empyema increased from 1997 to 2006, then declined to 2008. Bacterial pneumonia rates decreased to 1079 (95% CI 1059 to 1099) per million children and empyema rates decreased to 14 (95% CI 11 to 16) per million children. The RR for bacterial pneumonia admissions was 1.19 (95% CI 1.16 to 1.22) in 2006 compared with 2004 and 0.81 (95% CI 0.79 to 0.83) in 2008 compared with 2006. For empyema, the corresponding RRs were 1.77 (95% CI 1.38 to 2.28) in 2006 compared with 2004 and 0.78 (95% CI 0.62 to 0.98) in 2008 compared with 2006. CONCLUSION: Childhood bacterial pneumonia and empyema admission rates were increasing prior to 2006 and decreased by 19% and 22% respectively between 2006 and 2008, following the introduction of the PCV7 pneumococcal conjugate vaccination to the national childhood immunisation programme.


Subject(s)
Empyema, Pleural/prevention & control , Hospitalization/statistics & numerical data , Pneumococcal Vaccines/administration & dosage , Pneumonia, Bacterial/prevention & control , Adolescent , Age Distribution , Child , Child, Preschool , Empyema, Pleural/epidemiology , England/epidemiology , Female , Hospitalization/trends , Humans , Immunization Programs , Infant , Infant, Newborn , Male , Pneumonia, Bacterial/epidemiology , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/prevention & control , State Medicine/statistics & numerical data , State Medicine/trends , Vaccines, Conjugate/administration & dosage
16.
J Paediatr Child Health ; 45(7-8): 431-6, 2009.
Article in English | MEDLINE | ID: mdl-19722296

ABSTRACT

AIMS: To investigate the change in incidence of childhood empyema and pneumonia in Australia, and ascertain the management trends in all hospitals caring for children with empyema. METHODS: The incidences of empyema and pneumonia were calculated for each year between 1993/1994 and 2004/2005 using retrospective primary diagnostic coding from ICD-9 and 10 comprising the Australian National Hospital Morbidity Database for five age groups in patients less than 20 years of age. Hospitals with allocated paediatric beds were surveyed on referral pattern and treatment preferences. RESULTS: In this study, 145 562 patients with pneumonia were admitted with a mean (range) incidence of 2306 (1846-2652) per million. The trend towards an overall increase was not statistically significant. Only the 1-4 years old age group demonstrated a significant increase (P < 0.01, r2 = 0.61). A total of 469 cases of empyema were identified with a mean incidence of 7.35 (4-10.2) per million. There was an overall increase in incidence (P < 0.05, r2 = 0.51) reflecting an increase in the 1- to 4-year-olds (P < 0.005, r2 = 0.60) and 15- to 19-year-olds (P < 0.05, r2 = 0.37). The overall percentage of empyema as a proportion of pneumonia increased from 0.27 to 0.70% (0.48% (0.27-0.70%), P < 0.05, r2 = 0.38). The survey response rate was 75%. Ninety-nine of 121 (82%) hospitals referred children with empyema to a more appropriate centre with wide variations in treatments provided. CONCLUSIONS: The rise in incidence of empyema reflects that seen in other countries. Furthermore, there are diverse management practices suggesting a clear need for national guidelines.


Subject(s)
Empyema, Pleural/epidemiology , Pneumonia/epidemiology , Adolescent , Australia/epidemiology , Child , Child, Preschool , Empyema, Pleural/prevention & control , Heptavalent Pneumococcal Conjugate Vaccine , Hospital Records , Humans , Incidence , Infant , Linear Models , Pneumococcal Vaccines/administration & dosage , Pneumonia/prevention & control , Retrospective Studies , Vaccination/statistics & numerical data
17.
Tex Heart Inst J ; 36(4): 298-302, 2009.
Article in English | MEDLINE | ID: mdl-19693302

ABSTRACT

Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. Seven of the patients were chronically immunosuppressed, 5 were severely malnourished (median preoperative serum albumin level, 2.4 g/dL), and 5 had severe underlying obstructive pulmonary disease (median forced expiratory volume in 1 second, 44% of predicted level). Three upper lobectomies and 1 completion pneumonectomy were performed in order to treat massive hemoptysis that was secondary to complex aspergilloma. One patient underwent left pneumonectomy due to ruptured-cavitary primary lung lymphoma. One upper lobectomy was performed because of necrotizing, localized Mycobacterium avium-intracellulare infection. One patient underwent right upper lobectomy and main-stem bronchoplasty for carcinoma after chemoradiation therapy. In 3 patients, the pedicled latissimus dorsi muscle was used to obliterate chronic empyema cavities and to buttress the closure of underlying bronchopleural fistulas. No operative deaths or recurrent empyemas resulted. Two patients retained peri-flap air that required no surgical intervention. We conclude that the use of transposed pedicled latissimus dorsi muscle flap effectively and reliably prevents clinically overt bronchopleural fistula and recurrent empyema. We advocate its routine use in first-time and selected reoperative thoracotomies in patients who are undergoing high-risk lung resection or reparative procedures.


Subject(s)
Bronchial Fistula/prevention & control , Empyema, Pleural/surgery , Lung Diseases/surgery , Muscle, Skeletal/transplantation , Pleural Diseases/prevention & control , Pneumonectomy/adverse effects , Respiratory Tract Fistula/prevention & control , Surgical Flaps , Adult , Aged , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/etiology , Empyema, Pleural/diagnostic imaging , Empyema, Pleural/etiology , Empyema, Pleural/prevention & control , Female , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/etiology , Male , Middle Aged , Pleural Diseases/diagnostic imaging , Pleural Diseases/etiology , Respiratory Tract Fistula/diagnostic imaging , Respiratory Tract Fistula/etiology , Retrospective Studies , Risk Factors , Secondary Prevention , Thoracotomy/adverse effects , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
18.
Adv Exp Med Biol ; 634: 61-8, 2009.
Article in English | MEDLINE | ID: mdl-19280849

ABSTRACT

Empyema is apparently becoming more common, with pneumococcus being the most common pathogen detected in Europe and the USA. However, group A streptococcus and S. aureus pneumonia are individually more likely to progress to empyema. Serotype 1 pneumococcus is frequently implicated and the reasons for an apparent increase in incidence remain unclear. Management requires antibiotics and removal of pus either by fibrinolysis or primary drainage.


Subject(s)
Bacterial Infections/therapy , Empyema, Pleural/microbiology , Empyema, Pleural/therapy , Bacteria/pathogenicity , Bacterial Infections/epidemiology , Bacterial Infections/microbiology , Bacterial Infections/prevention & control , Child , Disease Management , Empyema, Pleural/epidemiology , Empyema, Pleural/prevention & control , Female , Humans , Male , United Kingdom/epidemiology , Virulence
19.
Eur J Pediatr ; 168(1): 51-8, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18461362

ABSTRACT

An increased occurrence of complicated parapneumonic effusions in children has been reported from the UK and USA. Data from mainland Europe are scarce. We investigated the incidence of complicated parapneumonic effusion and empyaema in children admitted to the University Hospital of Leuven between 1993 and 2005, an era when pneumococcal conjugated vaccination had not yet been implemented. Sixty-eight cases were identified. The incidence increased from 20-55/100,000 hospital admissions to 120-130/100,000 hospital admissions in 2005, with 50% of the cases occurring from 2003 onwards (late cohort). This increase occurred later than that reported in the UK and US, but is of similar magnitude. The median patient age was 3.6 years (range 0.5-17 years). The median duration of symptoms before admission was 4 days (quartile values 3-7 days). The median white blood cell (WBC) count was 15,450 WBC/mm3 (quartile values 11,300-21,200 WBC/mm3) and the median C-reactive protein (CRP) level was 242 mg/L (quartile values 143-344 mg/L). Patients in the late cohort seemed to have worse disease compared to early cohort patients; significantly higher pleural lactate dehydrogenase (LDH) level (P = 0,02), higher pleural WBC, lower pleural glucose level and significantly longer duration of hospitalisation in the later cohort (P < 0,05), possibly reflecting more severe disease. In both cohorts, Streptococcus pneumoniae was the most frequently isolated pathogen, with serogroup 1 prevailing. The occurrence of complicated parapneumonic effusion increased in Belgian children before pneumococcal vaccination was added to routine childhood immunisations. This increase is pronounced from 2003 onwards (late cohort) and, thus, occurred later than that reported in the UK and USA; several parameters point towards the occurrence of more serious disease in the late cohort patients.


Subject(s)
Pleural Effusion/epidemiology , Pleural Effusion/prevention & control , Pneumococcal Vaccines/administration & dosage , Adolescent , Belgium/epidemiology , Child , Child, Preschool , Empyema, Pleural/epidemiology , Empyema, Pleural/prevention & control , Female , Humans , Incidence , Infant , Male , Retrospective Studies , Time Factors
20.
J Thorac Cardiovasc Surg ; 136(1): 179-85, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18603072

ABSTRACT

OBJECTIVE: Postpneumonectomy empyema remains a clinical challenge. We proposed an accelerated therapy without an open chest window 5 years ago. This concept was evaluated on a larger scale in 2 centers in 2 different countries. METHODS: Between July 1995 and October 2005, 75 consecutive patients with postpneumonectomy empyema were treated in Szczecin, Poland (n = 35), and Zurich, Switzerland (n = 40). The therapy consisted of repeated open surgical debridement of the pleural cavity after achievement of general anesthesia, a negative pressure wound therapy of the temporarily closed chest cavity filled with povidone-iodine-soaked towels, and continuous suction and systemic antimicrobial therapy. If present, bronchopleural fistulae were closed and reinforced either with a muscle flap or the omentum. Finally, the pleural space was filled with an antibiotic solution and definitively closed. RESULTS: Of 75 patients (63 men; median age, 59 years; age range, 19-82 years), postpneumonectomy empyema was present on the right in 46 patients (32 with bronchopleural fistula) and in 29 patients (12 with bronchopleural fistula) on the left. Median time between pneumonectomy and postpneumonectomy empyema was 131 days (range, 7-7200 days). Bronchopleural fistulae have been closed and additionally reinforced by means of different methods (omentum, 18; muscle, 11; pericardial fat, 5; azygos vein, 1). The chest was definitively closed within 8 days in 94.6% of patients. The median hospitalization time was 18 days (range, 9-134 days). Postpneumonectomy empyema was successfully treated in 97.3% of patients, including 10 (13%) patients who needed a second treatment cycle. Three (4%) patients died within 90 days. The median follow-up time was 29.5 moths (range, 3-107 months). CONCLUSIONS: Treatment of postpneumonectomy empyema with the accelerated treatment is effective and safe. Our results are superior compared with those in reported series using a (temporary) chest fenestration. Patients appreciate the physical integrity of the chest.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Debridement/methods , Empyema, Pleural/microbiology , Empyema, Pleural/prevention & control , Pleural Cavity/surgery , Pneumonectomy/adverse effects , Surgical Wound Infection/prevention & control , Adult , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Cohort Studies , Empyema, Pleural/mortality , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Pleural Cavity/microbiology , Pneumonectomy/mortality , Poland , Surgical Wound Infection/microbiology , Survival Rate , Switzerland
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