European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
December 9, 2025 · via Europe PMC
Pediatric Empyema in the Post-Pandemic Period: Evaluating Changing Trends in Microbiology, Investigations, Fibrinolysis, and Surgical Outcomes.
Cao KX, Xilas E, Seago I, Abdelbary M, Jawaid W, Aslam A.
AI summary — for doctors, generated from the abstract only
Post-pandemic pediatric empyema affected younger children, was more often caused by S. pyogenes, and saw fibrinolysis failure and surgery rates rise substantially.
What was studied
A retrospective single-center UK review of 86 pediatric empyema cases over 8 years spanning pre-pandemic, pandemic, and post-pandemic periods including the 2022-2023 iGAS surge.
Key findings
- Median age fell from 9.9 to 6.2 to 4.4 years across periods
- 16S PCR raised organism detection from 27% (culture) to 90.7%
- S. pyogenes 43.4%, S. pneumoniae 30.2%
- Viral coinfection associated with necrosis (45% vs 24%)
- Fibrinolysis effectiveness fell from 81% to 60%; further surgery rose from 19% to 48%
- Length of stay rose from 8 to 11 days; no deaths
Clinical relevance
This suggests clinicians should be alert to higher fibrinolysis failure in the post-pandemic era and supports evaluating 16S PCR and earlier surgical consultation, though data come from one center retrospectively.
Who should care
Limitations
Retrospective single-center study, modest sample, period comparisons may be confounded.
Empyema has changed post-pandemic: younger, more Strep pyogenes, and more fibrinolysis failure.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
We present a retrospective analysis of our experience managing pediatric empyema, focusing on clinical, microbiological, radiological aspects, surgical and fibrinolytic outcomes over an 8-year period, encompassing the 2022-2023 United Kingdom invasive group A Streptococcus (iGAS) surge. This observational study aimed to test the hypothesis that the post-pandemic period has revealed a new pattern of microbes, disease patterns, and treatment effectiveness.
Materials and methods
Case notes of children (<16 years) with thoracic empyema who had an intercostal drain between 2014 and 2023 were reviewed for demographic, imaging, microbiological, and operative findings. Periods were categorized as pre-pandemic (2015-2020), pandemic (2020-2021), and post-pandemic (2022-2023).
Results
From 86 cases, median ages fell from 9.9 years (pre-pandemic), 6.2 years (pandemic), to 4.4 years (post-pandemic). Pleural culture detected organisms in 27% while 16S PCR increased the yield to 90.7%. Streptococcus pyogenes (43.4%) and Streptococcus pneumoniae (30.2%) predominated. Viral coinfection was associated with necrosis (45% vs. 24% without coinfection). Intrapleural fibrinolysis effectiveness fell from 81% pre-pandemic to 60% post-pandemic, with a concomitant rise in need for further surgery from 19% to 48%. Alongside these changes, the length of stay increased from 8 to 11 days (pre- vs. post-pandemic). There were no empyema-related deaths at our center over this study period.
Conclusion
Post-pandemic empyema was characterized by younger age, a higher proportion of S. pyogenes, and increased intrapleural fibrinolytics failure and surgery. These data support earlier surgical consultation for younger patients or those with viral coinfections, prospective evaluation of dual-agent fibrinolysis in children, and integration of 16S PCR into pleural workflows. Ongoing surveillance of empyema epidemiology is needed to optimize future management.
DOI
10.1055/a-2766-6940
PMID
41365379
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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