Microbiological profile and role of streptokinase in empyema thoraces in children – A retrospective and observational study from a tertiary care teaching hospital from North Karnataka

Abstract

Objectives: Paediatric empyema thoracis causes significant childhood morbidity and mortality over the years. The organisms causing empyema are varying. The role of streptokinase in management is still not clear. Hence, we undertook this study to find the profile of organisms and role of streptokinase in our cases. Materials and Methods: A retrospective study was conducted at the Department of Pediatrics, Karnataka Institute of Medical Sciences (KIMS), Hubli from 2017 to 2019. All children aged 2 months–12 years with empyema included. Case sheets were collected from medical records department. The detailed demographic, clinical history, examination findings and treatment received were recorded and entered in a pre-designed performa with a special emphasis on streptokinase usage including indications, dose and outcome. Institution ethical clearance was obtained from Institute Review Board (IRB). Results: Thirty-three children fulfilled inclusion criteria during the study period. Mean age was 5.25 ± 1.14 years with male to female ratio of 1.2:1. Most common age group was 1–5 years (39.39%). Clinical manifestations at presentation were fever 100% (33), cough 87.8% (29), dyspnoea 78.78% (26) and intercostal bulge 36.36% (12). Staphylococcus aureus (54.54%) and Streptococcus pneumonia (18.18%) were the most common organisms isolated in pleural fluid. However, blood culture was positive in only one child (non-fermenting Gram-negative bacilli). Fourteen (35%) children received streptokinase. Among those subjects who received streptokinase, 100% were improved as compared to who did not receive (11.5% mortality); however, there was no statistical significance. Although there was decreased duration of hospital stay in streptokinase group (13.79 ± 4.51 vs. 14.73 ± 8.26 days), again this was not statistically significant. Conclusion: The most common organism causing empyema was S. aureus. Although use of streptokinase showed better outcome and decreased duration of hospital stay, this was not statistically significant.