Pediatrik plevral efüzyonların etiyolojik, klinik ve mikrobiyolojik özellikleri: on yıllık retrospektif bir çalışma

Year 2025, Volume: 6 Issue: 5, 452 - 457, 24.10.2025

Hanife Tuğçe Çağlar , Sevgi Pekcan , Gökçen Ünal , Fatih Ercan , Fatma Nur Ayman , Suat Savaş , Bahar Ece Tokdemir , Özge Metin Akcan , Mustafa Gençeli

Abstract

Amaç: Plevral efüzyonu olan pediatrik hastaların klinik, mikrobiyolojik ve laboratuvar özelliklerini değerlendirmek ve uzun süreli hastanede kalışla ilişkili faktörleri belirlemek.
Yöntemler: Bu retrospektif çalışmaya, Ocak 2015 ile Aralık 2024 tarihleri arasında plevral efüzyon nedeniyle hastaneye yatırılan 0-18 yaş arası hastalar dahil edildi. Hastaların demografik özellikleri, yatış zamanı, yatış semptomları, plevral efüzyon özellikleri, ampiyem varlığı, efüzyon nedeni, solunum virüs paneli sonuçları, hastanede kalış süresi ve tedavi kaydedildi.
Sonuçlar: Toplam 119 hasta çalışmaya dahil edildi. En sık görülen etiyoloji parapnömik efüzyon (n = 86, %70,6) idi, bunu tüberküloz (n = 12, %10,1) ve malignite (n = 11, %9,2) izledi. Eksüda olan 60 hastanın 25'inde (%41,7) ampiyem vardı. En sık tespit edilen bakteriler Staphylococcus aureus ve Streptococcus pneumoniae idi. Solunum yolu viral koenfeksiyonları, özellikle rinovirüs ve influenza A, önemli bir oranda gözlendi. Ampiye, süperenfeksiyon ve plevral septasyon, uzun süreli hastanede kalış süresi ile anlamlı bir şekilde ilişkiliydi (sırasıyla p = 0,018, 0,022 ve 0,012). Efüzyon derinliği ile yatış süresi arasında orta derecede bir korelasyon bulundu (r = 0,378, p < 0,001).
Sonuç: Parapnömik efüzyon, pediatrik plevral efüzyonun başlıca nedeni olmaya devam etmektedir. Ampiye, süperenfeksiyon ve septasyon varlığı hastane yatış süresini önemli ölçüde uzatmaktadır, bu da erken tanı ve hedefe yönelik müdahalenin önemini vurgulamaktadır. Viral koenfeksiyonların hastalığın ciddiyetindeki rolü, ileri prospektif araştırmaların yapılmasını gerektirmektedir.

Keywords

Pediatrik plevral efüzyon , ampiyem , parapnömonik efüzyon , viral koenfeksiyon , Staphylococcus aureus , Streptococcus pneumoniae

Etiologic, clinic, and microbiologic characteristics of pediatric pleural effusions: a ten-year retrospective study

Abstract

Aims: To evaluate the clinical, microbiological, and laboratory characteristics of pediatric patients with pleural effusion, and to identify factors associated with prolonged hospitalization.
Methods: This retrospective study included patients aged 0-18 years who were hospitalized with pleural effusion between January 2015 and December 2024. Demographics, admission timing, clinical presentation, pleural effusion features, microbiological and viral findings, treatments, and outcomes were analyzed.
Results: A total of 119 patients were included, of whom 71.4% were admitted after the onset of the COVID-19 pandemic. The most common etiology was parapneumonic effusion (70.6%), followed by tuberculosis (10.1%) and malignancy (9.2%). Among exudative effusions, empyema was identified in 41.7%. Staphylococcus aureus and Streptococcus pneumoniae were the most frequent bacterial isolates, while rhinovirus and influenza A were the most common viral pathogens. In univariate analyses, empyema, superinfection, and pleural septation were associated with longer hospital stay. Multivariate regression confirmed superinfection, septation, and non-parapneumonic etiologies as independent predictors of prolonged hospitalization. A moderate positive correlation was found between effusion depth and length of stay (r=0.378, p<0.001). Most patients responded well to tube thoracostomy and fibrinolytic therapy, with only a minority requiring video-assisted thoracoscopic surgery.
Conclusion: This decade-long study highlights the continuing predominance of parapneumonic effusion in children, with notable contributions from tuberculosis and malignancy. The novelty of our findings lies in the combined evaluation of bacterial, viral, and structural risk factors, identifying septation, superinfection, and non-parapneumonic causes as key determinants of prolonged hospitalization. The post-pandemic increase in admissions may reflect shifts in healthcare access and pathogen profiles. Early recognition of high-risk features and timely treatment, including fibrinolytic therapy as a less invasive alternative to surgery, may help reduce hospital stays and improve outcomes.

Keywords

Pediatric pleural effusion , empyema , parapneumonic effusion , viral co-infection , Staphylococcus aureus , Streptococcus pneumoniae

References

• Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60 Suppl 1 (Suppl 1):i1-21. doi:10.1136/thx.2004.030676
• Langley JM, Kellner JD, Solomon N, et al. Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study. BMC Infect Dis. 2008;8(1):129. doi:10.1186/1471-2334-8-129
• Li ST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics. 2010;125(1):26-33. doi:10.1542/peds.2009-0184
• Byington CL, Spencer LY, Johnson TA, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 2002;34(4):434-440. doi:10.1086/338460
• Michelow IC, Olsen K, Lozano J, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. 2004;113(4):701-707. doi:10.1542/peds.113.4.701
• Hernández-Bou S, García-García JJ, Esteva C, Gené A, Luaces C, Muñoz Almagro C. Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol. 2009;44(12):1192-1200. doi:10.1002/ppul.21114
• Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77(4):507-513. doi:10.7326/0003-4819-77-4-507
• WHO announces COVID-19 outbreak a pandemic. https://www.euro.who.int/en/healthtopics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic (Accessed July 30, 2025)
• Feris-Iglesias J, Fernández J, Sánchez J, et al. Aetiology of paediatric pneumonia with effusion in the Dominican Republic and the potential impact of pneumococcal conjugate vaccines. Pneumonia (Nathan). 2014;4(1):8-15. doi:10.15172/pneu.2014.4/413
• Zhang X, Zhang H. Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009-2018. Turk J Pediatr. 2021;63(6):994-1003. doi:10. 24953/turkjped.2021.06.007
• Utine GE, Ozçelik U, Kiper N, et al. Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years. Turk J Pediatr. 2009; 51(3):214-219.
• Shiraishi Y, Kryukov K, Tomomatsu K, et al. Diagnosis of pleural empyema/parapneumonic effusion by next-generation sequencing. Infect Dis (Lond). 2021;53(6):450-459. doi:10.1080/23744235.2021.1892178
• Foster S, Maskell N. Bacteriology of complicated parapneumonic effusions. Curr Opin Pulm Med. 2007;13(4):319-323. doi:10.1097/MCP. 0b013e3281864691
• Robinson KM, Kolls JK, Alcorn JF. The immunology of influenza virus-associated bacterial pneumonia. Curr Opin Immunol. 2015;34:59-67. doi:10.1016/j.coi.2015.02.002
• Robinson KM, Ramanan K, Tobin JM, et al. Survival during influenza-associated bacterial superinfection improves following viral- and bacterial-specific monoclonal antibody treatment. JCI Insight. 2019; 4(14):e125554. doi:10.1172/jci.insight.125554
• Faure-Dupuy S, Jubrail J, Depierre M, et al. ARL5b inhibits human rhinovirus 16 propagation and impairs macrophage-mediated bacterial clearance. EMBO Rep. 2024;25(3):1156-1175. doi:10.1038/s44319-024-00069-x
• Barchi L, Barbi E, Zamagni G, De Fanti A, Iughetti L, Trombetta A. Is there an increased number of community-acquired pneumonia requiring drainage placement in children after COVID-19 pandemic in Italy? Pediatr Pulmonol. 2024;59(11):3032-3036. doi:10.1002/ppul.27150
• Addala DN, Rahman NM. Improving prognostication in empyema: is computed tomography the answer? Ann Am Thorac Soc. 2023;20(6):790-791. doi:10.1513/AnnalsATS.202303-185ED
• Soriano T, Alegre J, Alemán C, et al. Factors influencing length of hospital stay in patients with bacterial pleural effusion. Respiration. 2005;72(6):587-593. doi:10.1159/000087366
• Taghizadeh N, Fortin M, Tremblay A. US hospitalizations for malignant pleural effusions: data from the 2012 national inpatient sample. Chest. 2017;151(4):845-854. doi:10.1159/000485934
• Shaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology. 2019;24(10):962-971. doi:10.1111/resp.13673
• Cremonesini D, Thomson AH. How should we manage empyema: antibiotics alone, fibrinolytics, or primary video-assisted thoracoscopic surgery (VATS)? Semin Respir Crit Care Med. 2007;28(3):322-332. doi: 10.1055/s-2007-981653
• Shirota C, Uchida H. Initial treatment of septated parapneumonic empyema with drainage plus fibrinolytic agents is equally effective as video-assisted thoracoscopic surgery, and is suitable as first-line therapy. Transl Pediatr. 2015;4(1):41-44. doi:10.3978/j.issn.2224-4336.2015.02.01
• Samancilar O, Akçam Tİ, Kaya SO, Ozturk O, Akcay O, Ceylan KC. The efficacy of VATS and intrapleural fibrinolytic therapy in parapneumonic empyema treatment. Ann Thorac Cardiovasc Surg. 2018;24(1):19-24. doi: 10.5761/atcs.oa.17-00153