A J McKee1, A Ives, I M Balfour-Lynn. 1. Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK.
Abstract
BACKGROUND: The frequency of complicated pneumococcal disease, including necrotizing pneumonia, has increased over the last decade. During 2008-2009, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause. METHODS: This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002 to 2007, compared with 2008 to 2009. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without. RESULTS: During the 8-year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (P<0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs. 10 days, P<0.0001) and surgical intervention rate (2% vs. 14%, P=0.001). In the latter 2 years, S. pneumoniae serotype 3 was identified in 10/16 (91%) of those with a bronchopleural fistula compared to 1/33 (3%) of those without. CONCLUSIONS: The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-2009. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar® in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence.
BACKGROUND: The frequency of complicated pneumococcal disease, including necrotizing pneumonia, has increased over the last decade. During 2008-2009, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause. METHODS: This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002 to 2007, compared with 2008 to 2009. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without. RESULTS: During the 8-year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (P<0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs. 10 days, P<0.0001) and surgical intervention rate (2% vs. 14%, P=0.001). In the latter 2 years, S. pneumoniae serotype 3 was identified in 10/16 (91%) of those with a bronchopleural fistula compared to 1/33 (3%) of those without. CONCLUSIONS: The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-2009. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar® in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence.
Authors: T K Pandian; Johnathon M Aho; Daniel S Ubl; Christopher R Moir; Michael B Ishitani; Elizabeth B Habermann Journal: Pediatr Surg Int Date: 2015-10-31 Impact factor: 1.827
Authors: Marijke Proesmans; Brenda Gijsens; Patricia Van de Wijdeven; Herbert De Caluwe; Jan Verhaegen; Katrien Lagrou; Ellen Van Even; Francois Vermeulen; Kris De Boeck Journal: Eur J Pediatr Date: 2014-05-17 Impact factor: 3.183
Authors: Florian J Segerer; Karin Seeger; Anna Maier; Christine Hagemann; Christoph Schoen; Mark van der Linden; Andrea Streng; Markus A Rose; Johannes G Liese Journal: Pediatr Pulmonol Date: 2016-09-20