European Journal of Pediatrics

, Volume 173, Issue 10, pp 1339–1345 | Cite as

Clinical outcome of parapneumonic empyema in children treated according to a standardized medical treatment

  • Marijke Proesmans
  • Brenda Gijsens
  • Patricia Van de Wijdeven
  • Herbert De Caluwe
  • Jan Verhaegen
  • Katrien Lagrou
  • Ellen Van Even
  • Francois Vermeulen
  • Kris De Boeck
Original Article


Treatment of parapneumonic empyema (PE) consists of intravenous antibiotics and, in case of large effusions and persisting fever, pleural chest drain (±intrapleural fibrinolytics) or video-assisted surgical intervention. We standardized the treatment for PE in our tertiary care center choosing a first-step nonsurgical approach. The aim was to evaluate the need for surgery and to collect data on disease course, outcome, and microbiology. For all children treated for PE between 2006 and 2013, data were prospectively collected concerning treatment, length of stay, duration of fever, complications, and causative agent. Of 132 children treated for PE, 20 % needed surgical intervention. Analyzed per year, the need for surgery decreased from almost 40 % in 2007 to 0 % in 2010 again increasing to 40 % although this did not reach statistical significance (p = 0.115). Median duration of “in-hospital fever” was 5 days (IQR, 3–8). The duration of fever correlated with pleural LDH (r = 0.324; p = 0.002) and pleural glucose (r = −0.248; p = 0.021) and was inversely correlated with pleural pH (r = −0.249; p = 0.046). Based on pleural PCR data, 85 % of PE were caused by Streptococcus pneumoniae (40 % serotype 1). Conclusion: After introduction of a standardized primary medical approach (chest drain ± fibrinolysis) for PE in our institution, the need for surgical rescue interventions overall remained at 20 %, which is higher than in some other reports. Difference in microbiology or disease severity could not be proven.


Empyema Children Treatment Etiology 

List of abbreviations


Length of stay


Parapneumonic empyema




Video-assisted thoracoscopic surgery


Conflict of interest

The authors declare no conflict of interest. This is a nonsponsored study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Marijke Proesmans
    • 1
  • Brenda Gijsens
    • 1
  • Patricia Van de Wijdeven
    • 1
  • Herbert De Caluwe
    • 2
  • Jan Verhaegen
    • 3
  • Katrien Lagrou
    • 3
  • Ellen Van Even
    • 3
  • Francois Vermeulen
    • 1
  • Kris De Boeck
    • 1
  1. 1.Department of Pediatrics, Pediatric PulmonologyUniversity Hospital of LeuvenLeuvenBelgium
  2. 2.Department of Thoracic SurgeryUniversity of LeuvenLeuvenBelgium
  3. 3.Department of MicrobiologyUniversity of LeuvenLeuvenBelgium

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