Prehospital antibiotics reduce complications in children with pleural effusion/empyema

Prehospital antibiotic therapy (PH-ABT) leads to a marked decrease in the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction, in children with parapneumonic pleural effusion (PPE) and pleural empyema (PE), a study has found. PH-ABT also results in a reduced rate of infectious complications but does not have an impact on the overall disease duration.

“We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment,” the authors said.

A prospective nationwide active surveillance was conducted in Germany between June 2018 and October 2020 to analyse the effects of PH-ABT on clinical outcome and pathogen detection. A total of 1,724 children and adolescents aged <18 years with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were recruited.

Of the patients with available data (n=1,719), 556 (32.3 percent) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs 18 days; p<0.001), a longer time from onset of symptoms until hospital discharge (25 vs 23 days; p=0.002), a lower rate of intensive care unit admission (58.3 percent vs 64.4 percent; p=0.015), and fewer infectious complications (5.9 percent vs 10.0 percent; p=0.005) than those without PH-ABT.

Blood or pleural fluid culture in 597 (34.5 percent) of 1,513 children yielded bacterial pathogens. Positive culture results occurred less frequently in children with vs without PH-ABT (81/466 [17.4 percent] vs 299/1,005 [29.8 percent]; p<0.001), but detection rates in pleural fluid samples by polymerase chain reaction were comparable (91/181 [50.3 percent] vs 220/398 [55.3 percent]; p=0.263).

“PPE/PE are complications of community-acquired pneumonia,” the authors said.