6582 Clinical audit showing the increased incidence of group A streptococcus empyema at a tertiary cardiothoracic paediatric centre over the first six month of 2023

Objectives Pleural empyema is a relatively uncommon problem in general paediatrics, worldwide incidence ranged from 0.7 – 3.3 per 100,000.¹ Streptococcus Pneumonia has been the most common causative organism.²Since September 2022 a rise of pleural empyema associated with group A streptococcus (GAS) was noted in three tertiary centres in the UK.³ We aim to highlight the overall increase in cases and the predominance of GAS in our Tertiary Centre at Children's Health Ireland at Crumlin. Methods Data was collected retrospectively for patients with empyema admitted under respiratory team in CHI at Crumlin (cardiothoracic tertiary centre) between the1st January and 30th June 2023. This was compared to data obtained from the Microbiology department for the years 2020 and 2021 in the same centre. Data was collected regarding patient's demographics, logistics and microbiology. Results During the first 6 months of 2023, a total of 41 patients presented for surgical management of empyema, 22 (53.6%) were GAS positive. The mean age of the patients was 4 years (range 1.5–15 years). This compares to a total of 34 patients over 24 months (2020 to 2021) with only 2 (5%) GAS positive on pleural PCR. The mean age of the patients was 7 years (range 1–15 years). This demonstrates a greater than 4 fold increase in the number of cases and a 10 fold increase in GAS associated empyema. Conclusion In comparison to the previous years, there has been a greater than 4 fold increase in empyema presenting for surgical intervention. GAS was the predominant organism on pleural PCR with a 10-fold increase demonstrated. The most affected age group was the pre-school aged child. References Pleural empyema management guidelines, Department of Respiratory Medicine and Cardiothoracic Surgery, 2019 https://media.childrenshealthireland.ie/documents/Pleural-Empyema.pdf. Empyema Talk-IPA, Department of respiratory medicine and cardiothoracic surgery, 2015. National case series of group A streptococcus pleural empyema in children: clinical and microbiological features, The Lancet Infectious Diseases, 2023 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00008-7/fulltext.