Drainage of bacterial pleuropneumonia in children: A 13-year retrospective monocentric study

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INTRODUCTION: There is no consensus on indications and modalities of drainage procedures for bacterial pleuropneumonia in children. This study aimed to analyze the clinical course following drainage procedures and the different techniques used. METHOD: This retrospective single-center study included children with drained bacterial pleuropneumonia at a French University Hospital, from January 1, 2011, to December 31, 2023. RESULTS: Thirty-three children were included, with a median age of 3.3 years. The most frequently identified pathogens were Staphylococcus aureus (n = 13; 39 %), Streptococcus pyogenes (GAS) (n = 9; 27 %), and Streptococcus pneumoniae (n = 5; 15 %). Indications for pleural drainage included respiratory distress (n = 16; 48 %) and persistent/abundant pleural effusion (n = 7; 21 %). 73 % of cases presented mediastinal deviation. Percutaneous drainage was performed for 23 patients (70 %) and surgical drainage for 10 patients (30 %). Drainage cultures were positive in 14/27 cases (52 %) after a median of 3 days (IQR: 1.2-5.5) of antibiotics. After drainage, the median durations of fever, intravenous antibiotics, and hospitalization were 8 (IQR: 4.2-14), 11 (IQR: 8.5-15), and 15.5 days (IQR: 8.7-18.5), respectively. Univariate analysis showed that children with percutaneous drainage had longer post drainage fever (12 vs. 5.3 days, p = 0.01) and ventilation durations (7 vs. 2.25 days, p = 0.02) than those with surgical drainage. CONCLUSION: The cohort had severe cases, with percutaneous drainage more commonly used. Positive drainage cultures highlighted the challenges of antibiotic penetration and supported the role of drainage in selected cases. Despite favorable medium-term outcomes, post-drainage recovery was prolonged, with extended durations of hospitalization, persistent fever, and prolonged antibiotic treatment.

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