Empyema thoracis in a tertiary care centre: Analysing clinical trends and outcomes

Objectives: Despite advancements in antibiotic therapy, empyema thoracis continues to be a notable complication of bacterial pneumonia in children. This study aims to assess the clinical characteristics, therapeutic outcomes and long-term pulmonary function in paediatric patients diagnosed with empyema thoracis. Material and Methods: A retrospective observational study was carried out in the Department of Paediatrics, Karnataka Medical College and Research Institute, Hubballi, between January and June 2024. Hospital records were reviewed to collect data on demographics, clinical features, laboratory findings, treatment modalities and pulmonary function tests (PFTs) performed 6 months post-discharge. The study population included children aged 1 month to 12 years with confirmed pyogenic empyema. Exclusion criteria comprised tuberculous pleural effusion, prior chest tube insertion, significant chest wall deformities and post-traumatic empyema. Results: Of 2,171 paediatric admissions during the study period, 32 children (1.47%) were diagnosed with empyema thoracis. The majority of affected children (68.7%) were between 5 and 12 years of age, with a male predominance (62.5%). All patients presented with fever and cough, and 75% were undernourished. Pre-hospital antibiotic use was reported in 62.5% of cases. Bacterial cultures, including those from the pleural fluid, were largely sterile, with only one case yielding methicillin-resistant Staphylococcus aureus with multidrug resistance. Treatment consisted of antibiotics alone in 12.5% of cases, antibiotics with intercostal chest drainage (ICD) in 40.2% and thrombolytics in addition to ICD in 31.2%. Video-assisted thoracoscopic surgery (VATS) was performed in 15.6% of cases to facilitate pleural adhesiolysis, debridement and decortication. First-line antibiotics (ceftriaxone and vancomycin) were effective in 68.7% of patients, and 71.2% became afebrile within 7 days. The average hospital stay was 21 days for those managed with ICD alone and 17 days for those undergoing VATS. The mean ICD duration was 6 days in conventionally treated patients and 3 days in the VATS group. Follow-up PFTs were available in 12 patients, revealing restrictive lung patterns in 33%, with the remainder showing normal lung function. Conclusion: Empyema thoracis remains a significant paediatric condition requiring timely intervention. The combination of antibiotics and ICD remains the mainstay of treatment, while VATS offers improved clinical outcomes, including shorter hospital stays and quicker recovery. Long-term pulmonary function is generally favourable, although a minority of children may develop restrictive lung disease.