Paediatric empyema in New Zealand: a tale of two cities

AIMS: We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate. METHODS: Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively. RESULTS: Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S. aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Maori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S. pneumoniae pleural antigen were important in diagnosis. CONCLUSIONS: Our audit confirms the important role of S. aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendations at both centres would cover more than 80% of pathogens, although MRSA is a significant contributor.