Clinical characteristics and outcomes of children with pleural empyema: a prospective cohort study

Background: Multiple European countries reported a rise in paediatric admissions with pleural empyema, linked with increased invasive group A streptococcus (GAS) disease in 2022.Aim: To describe clinical characteristics and short-medium term outcomes in paediatric empyema.MethodSingle-centre prospective cohort study of children admitted with pleural empyema from Nov 2022 to Jun 2023. Clinical characteristics and demographics are described. Each patient had a repeat chest x-ray (CXR) 2 weeks post-discharge and a review at 4-6 months with CXR and spirometry.Results: 25 children (68% male) with a median age of 4 years (1-16) were included. All children had primary immunisations, and had no respiratory or immunological comorbidity.Median length of hospital stay was 15 (10-21) days. 36% were invasively ventilated. 21 (84%) children needed drain insertion; 80% of whom received urokinase. 2 patients had video-assisted thoracoscopy.18(72%) had positive microbiology on blood culture (14), pleural fluid culture (4), 16S PCR (2) and/or sputum (2). Most common bacteria were GAS (11) and Streptococcus pneumoniae (4). 52% had a CT chest showing empyema, cavitation or necrotic areas.Radiological abnormalities persisted on all CXRs 2 weeks post-discharge. By 4-6 months, 15/25 (60%) of CXRs were clear. The remaining had minor residual changes. 5(20%) children had persistent respiratory symptoms or needed further antibiotics for chest infections; three of them had abnormal spirometry (FEV1 z-score <-1.64).Conclusion: Most children with empyema recover fully by 6 months; a few have ongoing clinical, radiological or lung function deficit, and need monitoring for longer term outcomes.