Retrospective review of empyema and parapneumonic effusions in hospitalized children in Ghana

Abstract

Objectives: Empyema and parapneumonic effusions (PPEs) are common complications of community-acquired pneumonia in children. Both contribute to prolonged hospital stay, increased morbidity, and less frequent mortality. This study aimed to describe the demographics, immunization status, clinical profile, etiology, and outcomes in children admitted with empyema and PPE to the Komfo Anokye Teaching Hospital. Materials and Methods: This was a retrospective cross-sectional study that reviewed folders and electronic records of children admitted from January 2016 to December 2020. Information on demographic characteristics, immunization status, clinical profile, date of admission, and discharge or death were documented. Information was extracted using Microsoft Excel. Data was then analysed with Stata statistical software package version 16. Results: Records were available for 51 out of 65 children, the median age was 42 months interquartile range (IQR) (22.5–96) and 68.6% (n = 35) of the children were males. Three of the children 5.9% did not have a chest drain inserted. In all, 60.8% (n = 31) of the children had received all doses of the pneumococcal conjugate vaccine (PCV) up-to-date for age. Four children (7.8%) had oxygen saturation <90%, whereas 43.9% (n = 18) had axillary temperature >38°C. Blood cultures were done for 72.6% (n = 37) of patients, Staphylococcus aureus was isolated in 5 patients (13.5%, n = 5/37) and Streptococcus pneumoniae was isolated in 1 patient (2.7%, n = 1/37). While the rest, 83.8% (n = 31) had no bacterial growth. The pleural aspirate culture was done in 64.7% (n = 33) of the patients and 6 (18.1%) had S. aureus isolated. Common antibiotics administered were amoxicillin clavulanic acid in 33.3% (n = 17) of the patients, and ceftriaxone in 31.4% (n = 16) of the patients. Three (5.9%) children died. The median length of hospital stay was 9 days IQR (7–14). Conclusion: Empyema and PPE occurred more commonly in children older than 1 year, with a low mortality rate among the children. Most children with empyema were full immunised with PCV-13.