BACTERIAL ETIOLOGY AND MORTALITY OF PURULENT PERICARDITIS IN PEDIATRIC-PATIENTS - REVIEW OF 162 CASES

Acute purulent pericarditis is an infrequent but potentially life-threatening disease. Early and effective treatment requires a knowledge not only of the clinical course but also of the microbial agents most commonly responsible. Several reviews have examined the etiology of purulent pericarditis, primarily in adult patients, but there has been no recent review of the disease in pediatric patients. Data on clinical and microbiological aspects of purulent pericarditis in infants and children are reviewed, based on a study of the literature. Of the 129 patients for whom the sex was stated in the reports, 73 (57%) were male. Bacteria were isolated from 146 of 162 patients (90%). Staphylococcus aureus, Haemophillus influenzae, Neisseria meningitidis and Streptococcus pneumoniae accounted for 130 of the 146 isolates. In adult patients, purulent pericarditis is most often caused by S. aureus and various streptoccoci. By contrast, in pediatric patients, H. influenzae and meningococci are 2nd in frequency only to S. aureus. Although the initial choice of antibiotic agents should be guided by Gram stain of pericardial fluid, these data suggest that parenteral therapy with a semisynthetic penicillinase-resistant penicillin (such as nafcillin, methicillin or oxacillin) and chloramphenicol is appropriate unless a definitive identification of Gram-positive or Gram-negative bacteria is made on Gram stain. Although purulent pericarditis is an infrequent disease, treatment with both antibiotics and surgical drainage of the pericardium appears to favorably affect the survival.