Empyema thoracis management: Medical vs Surgical

Empyema thoracis is an infectious process defined by pus formation within the pleural space in the thorax. It frequently develops following a bacterial pneumonia, as a continuum from a parapneumonic effusion. Its clinical course is classically divided into three stages: exudative, fibrinopurulent and organisational phases, which are not individually distinct. Although the causative agents in paediatric population vary, depending on the age, Streptococcus pneumoniae and Staphylococcus aureus were among the most commonly reported pathogens. Despite the improvement of antimicrobial therapy and availability of pneumococcal vaccines, hospitalisations for empyema were reported on the rise globally over the last decade and continued to be a major cause of morbidity in children. Various treatment options have been employed in the management of paediatric empyema thoracis based on the stage of the disease, including antibiotics, thoracocentesis, tube thoracostomy, intrapleural fibrinolytics, open window thoracostomy, video-assisted thoracoscopic surgery (VATS) and thoracotomy. The reported outcomes with these treatments have been highly variable. In spite of the availability of guidelines to facilitate standardisation of patient care, the proper management of empyema thoracis in children remains debatable.