PP27 PAEDIATRIC EMPYEMA THORACIS IN THE POST PNEUMOCOCCAL CONJUGATE VACCINE ERA

Letchumi Raja Sureia, Nasirah Rosli, Canace Ching Yee Teoh, Yee Yen Tan

Department of Paediatrics, Hospital Tengku Ampuan Rahimah Klang, Selangor, Malaysia

Introduction
Worldwide, the introduction of Pneumococcal Conjugate Vaccine (PCV) in the National Immunization Programme (NIP) has led to a reduction in pneumococcal disease. Malaysia included the PCV in the NIP since year 2020. However, we continue to see children affected with complicated pneumonia.      

Objective
To illustrate the cases of empyema thoracis since the introduction of PCV.  

Methodology
Retrospective review of clinical record of children with a diagnosis of empyema thoracis from 1/7/2020 to 30/6/2025.    

Results
There were a total of 20 patients with empyema thoracis, with a median age 3.5 years (range 0.3-10.5). 17 patients (85%) had a causative organism identified: 11 patients were positive for Streptococcus pneumoniae (Serotypes identified were 19A, 3, and 14). 17 patients (85%) required chest tube drainage for a median of 11 days (range 5-14). The most common complication was necrotizing pneumonia, affecting 8 patients (40%), followed by pneumothorax, affecting 5 patients (25%) and septic shock, affecting 4 patients (20%). 3 patients (15%) required surgical decortication. None required lung resection and all patients survived to discharge. The median length of hospital stay was 28 days (range 17-70). Of the 11 patients with Streptococcus pneumoniae as a causative organism, 7 were born before the year 2020 and did not receive the PCV as part of the NIP. In a similar review done from year 2015 to 2020 in the same institution with the same population, there were 28 patients with empyema thoracis.   

Conclusion
Post PCV era, there has been an overall reduction in the incidence of empyema thoracis. However, the disease burden remains, associated with a need for chest drainage for a vast majority of patients and prolonged hospitalization. Streptococcus pneumoniae continues to be the leading causative organism.