2024 19 Management of empyema in children

Pneumonia complicated by empyema (pus or infected fluid in the pleural space) is common in children. It is usually due to Streptococcus pneumonia, Streptococcus pyogenes, or Staphylococcus aureus (including MRSA), or tuberculosis. Bacterial empyema usually follows an upper respiratory tract virus infection, such as RSV or influenza. Paediatricians need to be able to manage empyema, as a child with this complication will not recover fully unless control of the source of infection is achieved. This usually requires draining the exudate in the pleural space. An empyema can be simple (cloudy fluid) or complex (thick pus with loculations or septations in the pleural cavity depending on how long it has been there). We need to know the indications for drainage of empyema; the safest technique to do so with sedation and local anaesthetic; how to use ultrasound and x-ray to assess size of the empyema and adequacy of drainage; and how to manage other aspects of care of children with empyema, including duration and type of antibiotics, and attention to nutrition.