Source: Annual Congress 2002 - Empyema thoracis in children
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

The incidence of empyema has increased in the last few years in Western Countries because of the emergence of drug-resistant bacterial species.
Out of 60 cases of hospitalized pneumonias over a period of two years (from Jan 2000 to Dec 2001), 3 cases of metapneumonic empyema were diagnosed.
All were females (aged 4 to 11 yr) and were admitted to the hospital because of persistent fever (38.1[degree]C ±]1.26) despite antibiotic therapy. At admission, chest X-ray detected an empyema formation; ESR[scquote]s were 40, 118 and 120 mm/h; C-reactive protein were < 3.47, 164 and 328 mg/l, and WBC were 11,700, 12,800 and 9,640/mm3 , respectively.
Urokinase (UK 50,000-100,000 UI) diluited in 20 ml of normal saline was instilled into the pleural cavity by the percutaneous placement of a tube for drainage. After 2 hrs, the clamped catheter was re-opened and then connected to water-seal suction at a negative pressure of 20 cm H2O. UK instillation was repeated daily until no further drainage occurred. The tube was kept in the pleural cavity for 5, 6 and 16 days and the total amount of fluid drained was 76 ml, 550 ml and 1310 ml, respectively.
The body temperature returned to normal values in all cases by the second day after positioning the drainage tube.
In two patients no bacteria was detected in the pleural fluid whereas the third patient presented a slight PCR-positivity for M. tubercolosis. No adverse reaction or other complications, such as pneumotorax or bleeding, were observed with the use of UK.
In conclusion, we support the use of intracavitary urokinase in the treatment of pediatric parapneumonic effusions because it is simple, safe and effective and it can reduce the risks associated with more invasive procedures, such as thoracotomy and debridement.

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Citations should be made in the following way:
L. Fasoli, M. Canciani, M. Don, P. Melli, F. De Franco, F. Braida, M. Cossettini, A. Tenore (Udine, Italy). Current management of empyema thoracis in childhood. Eur Respir J 2002; 20: Suppl. 38, 3692

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