Cavitatory lung disease complicating empyema in children

Objective: The incidence of empyema has increased dramatically in children in the UK over the last decade. Streptococcus pneumoniae (S. pneumoniae) serotype 1 is the dominant serotype. We have observed more pneumatocoele and bronchopleural fistulae formation over this time. Aim: Our aim was to determine the number of children who developed cavitatory disease as a complication of empyema at a tertiary referral centre and whether there was any association with S. pneumoniae serotype 1. Method: We reviewed 75 cases presenting with empyema or parapneumonic effusion between February 1997 and July 2003. Bacterial culture and pneumococcal antigen detection were supplemented by real-time polymerase chain reaction (PCR) to detect pneumococcal DNA. Results: Cavitatory disease was present in 15 cases. Three children developed bronchopleural fistulae. S. pneumoniae was detected in 13 of 15 cases (4 cases serotype 1, 3 serotype 3, 2 serotype 14, and 2 serotype 9V; serotype assay was not performed in two cases). Staphylococcus aureus (S. aureus) was isolated in one case. No organism was isolated in the final case but an Antistreptolysin-O titre was >800 U/ml on two occasions suggestive of group A streptococcal infection. Conclusion: Twenty percentage of cases of empyema in our series were complicated by cavitatory lung disease. It is an important complication of childhood empyema associated classically with S. aureus, but these data suggest that S. pneumoniae now appears to be the main cause. There does not seem to be an association with any particular serotype.