Paediatric Empyema in the Post-Pandemic Period: evaluating changing trends in microbiology, investigations, fibrinolysis and surgical outcomes.

INTRODUCTION We present a retrospective analysis of our experience managing paediatric empyema, focusing on clinical, microbiological, radiological aspects, surgical and fibrinolytic outcomes over an eight-year period, encompassing the 2022-23 UK 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 (<16years) with thoracic empyema who had an intercostal drain between 2014-2023 were reviewed for demographic, imaging, microbiology and operative findings. Periods were categorised as pre-pandemic (2015-20), pandemic (2020-21) 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% whilst 16S PCR increased yield to 90.7%. Strep.pyogenes (43.4%) and strep.pneumoniae (30.2%) predominated. Viral co-infection was associated with necrosis (45% vs.24% without co-infection). 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, length of stay increased from 8 to 11 days (pre vs. post-pandemic). There were no empyema-related deaths at our centre over this study period. CONCLUSIONS Post‑pandemic empyema was characterised by younger age, a higher proportion of s.pyogenes, and increased IF failure and surgery. These data support earlier surgical consultation for younger patients or those with viral co‑infections, prospective evaluation of dual‑agent fibrinolysis in children and integration of 16S PCR into pleural workflows. Ongoing surveillance of empyema epidemiology is needed to optimise future management.