Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007

Geneviève Deceuninck; Caroline Quach; Markos Panagopoulos; Roseline Thibeault; Thérèse Côté-Boileau; Bruce Tapiéro; Léna Coïc; Philippe De Wals; Philippe Ovetchkine

doi:10.1093/jpids/pit075

Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007

J Pediatric Infect Dis Soc. 2014 Jun;3(2):119-26. doi: 10.1093/jpids/pit075. Epub 2013 Dec 6.

Authors

Geneviève Deceuninck¹, Caroline Quach², Markos Panagopoulos³, Roseline Thibeault⁴, Thérèse Côté-Boileau⁵, Bruce Tapiéro³, Léna Coïc³, Philippe De Wals⁶, Philippe Ovetchkine³

Affiliations

¹ Quebec University Hospital Research Centre, Quebec City (QC), Canada.
² Division of Infectious Diseases, Department of Pediatrics and Medical Microbiology, The Montreal Children's Hospital and McGill University, and.
³ Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada.
⁴ Division of Infectious Diseases, Department of Pediatrics, CHU Quebec and Laval University, Quebec City, Quebec, Canada.
⁵ Department of Pediatrics, CHU Sherbrooke, Sherbrooke, Quebec, Canada.
⁶ Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada.

PMID: 26625364
DOI: 10.1093/jpids/pit075

Abstract

Background: Although the frequency of pneumonia has decreased over time, an increase in pleural empyema has been observed in different settings worldwide. This study assessed the epidemiology of community-acquired pediatric pleural empyema in the province of Quebec through validation of cases found in a hospitalization discharge database.

Methods: We used the national administrative database of hospitalization to identify children (6 months-14 years) hospitalized for pleural empyema or pleural effusion with drainage from January 1990 until December 2007 and reviewed their medical charts. Patients with pleural effusion secondary to chest trauma, thoracic surgery, malignancies, cardiac failure, or metabolic disorders were excluded.

Results: Predictive positive value (PPV) of empyema code in any position among discharge diagnostics in the administrative database was 86.5% (95% confidence interval: 81.9%-90.3%). After chart revision, 292 met the inclusion criteria. Age-adjusted incidence of pleural empyema in the pediatric population increased from 0.23 in 1990 to 4.01/100,000 person-years in 2007. A bacterial pathogen was identified in 46.5%; Streptococcus pneumoniae (Sp) (42%) and S pyogenes (30%) were most frequent. There was no obvious change in the PPV and proportions of children with chronic disease or asthma and in identified pathogens over time, but an increase in pre-admission respiratory symptoms duration (from 3.8 days to 5.7) and nonsteroidal anti-inflammatory drug use (from 0% to 19%) was observed.

Conclusions: From 1990 to 2007, we observed a 10-fold increase in the incidence of pediatric hospitalizations associated with pleural empyema. This increase preceded the introduction of a pneumococcal conjugated vaccine program in Quebec. Sp remained the major pathogen identified.

Keywords: database validation; epidemiology; pediatric population; pleural empyema.