The Survey of Pediatric Pleural Empyema in North of Iran (from 2004 to 2016)

Background: Pleural empyema is a collection of purulent exudate between the lungs and the chest wall. Despite the importance of the disease in children, no study has investigated it in Mazandaran province, Iran. The aim of this study was to evaluate the prevalence, clinical manifestations, diagnosis, treatment and its outcome in children referring to hospitals of Mazandaran during 12 years. Materials and Methods: In this cross-sectional study, medical records of all children aged 0 to 18 years admitted to 5 educational hospitals of Mazandaran province, Iran, with Tenth Revision, Clinical Modification (ICD-10-CM) codes confirming pleural empyema or effusion from March 2004 to 2016 were identified retrospectively. The clinical records were reviewed for demographic information, hospitalization information, medications, symptoms; laboratory and medical imaging results and the patient's condition on discharge were recorded. Statistical analysis was performed by SPSS version 20.0 software. Results: Of 50 patients with the mean age of 7.08±5.6 years, 31(62%) were boys and empyema incidence was higher (58%) in 5-18 year-old children.The mortality rate was 12% (6 patients).The most common microorganisms were Escherichia coliand Klebsiella (33.3%). In 17(34%) patients, antipyretics were prescribed prior to admission and pre-admission treatment regimen included beta-lactams with or without macrolides.The most commonly prescribed drug regimens were vancomycin and beta-lactam (50%), and the most common drug resistance of microorganisms was to ampicillin, cephalexin and ceftazidime. Conclusion: Since most of the gram-negative organisms in Mazandaran hospitals were Extended-Spectrum Beta-Lactamases (ESBL), and all the microorganisms of this study were susceptible to gentamicin, it is suggested to consider it in empiric therapy of pediatric pleural empyemain Mazandaran province. Also, lower rate of surgical intervention in children who received pre-admission antibiotics highlights the importance of antibiotic intervention before admission.