Introduction: Empyema is a serious complication of pneumonia.

Aims and Objectives: In autumn 2022, clinicians in the Midlands region, UK, noted an increase in the number of children presenting with empyema. We conducted a service improvement project to verify this and identify important trends.

Methods: A multicentre retrospective case series review was carried out on all children with empyema admitted to participating centres between 1st September and 30th November 2022. We collected and analysed anonymised data including demographics, presenting features, microbiological and radiological findings, treatment and outcomes.

Results: We identified 42 cases across the four participating centres (complete data for 35), compared to five cases in the same time period in 2019. A causative bacterial agent was identified in 60% of children (21/35), with invasive Group A betahaemolytic Streptococcus (iGAS) being most common (57%, 12/21). Viruses were identified in 34% (12/35). Median duration of admission was 13 days (figure 1), extending to 18 days for those with iGAS, and 20 days for those from the most deprived areas (Townsend quintile 5). Children with iGAS were at higher risk of requiring ICU admission (9/12 v 8/23 in non-iGAS group, RR=2.2).

Conclusion: Rate of admission with empyema was over 8 fold higher during the study period than three years previously. Those with iGAS had greater risk of ICU admission and longer duration of stay.