Complicated parapneumonic effusion and empyema thoracis: Microbiologic and therapeutic aspects

Abstract

Patients with pleural infections have a high risk of morbidity and mortality with prolonged hospitalization. The best methods for treating pleural infections remain debatable. Although the increasing drainage volume effect of streptokinase adjunctive to chest-tube, is well known, its effect on clinical outcomes like duration of hospitalization and need for further surgery, remains controversial. The aim of this study was to analyze the etiological and microbiological factors for pleural infections, and assess the effect of streptokinase adjunctive to chest tube for clinical outcomes. Charts of patients with a chest disease department discharge diagnosis of complicated parapneumonic effusion or empyema were retrospectively reviewed. Of the 107 patients (85 male), the mean age was 47.9+/-17.1 years. The most frequently shown bacteriological agent was Staphylococcus aureus. Drainage with thoracentesis was used in 44 patients (group 1); chest tube was performed in 44 patients (group 2) and intrapleural streptokinase was given after chest tube insertion in 19 patients (group 3). Mean hospitalization time in group 1 was shorter than the other two groups (P<0.05), but there was no significant difference between group 2 and 3. Our mortality rate was 8.4%. Success rates were 95.4%, 65.9% and 78.5% in groups 1, 2, and 3, respectively (P>0.05). Intrapleural streptokinase is a safe procedure but it did not effect the duration of hospitalization, mortality and success rate. Mortality remains especially high in patients with concomitant disease.

Current surgical treatment of thoracic empyema in adults

“…It is a complex clinical entity, neither a sole clinical, laboratory, nor a radiological diagnosis. A significant lack of detectable causative organisms (frank sterile pus) reported between 47% and 56% [9][10][11] complicates further definition. In this paper, the entities are discussed according to Light's classification of the parapneumonic effusions from 4 to 7 (i.e.…”

“…From 5% to 20% all post-or parapneumonic effusions become thoracic empyema [9,17]. Thirty percent or less of all the adult cases originate in thoracic surgical procedures (lung, oesophageal, mediastinal or other intrathoracic procedures) [18].…”

“…Pneumoniarelated (post-or parapneumonic effusion) complicated effusion and fibrinopurulent-stage empyema are the most frequent forms. Tuberculotic (specific) empyema, infected malignant pleural effusion and empyema of unknown origin or idiopathic are less frequent [4,5,[8][9][10][11]15,17].…”

The time course of resolution of adhesions during fibrinolytic therapy in tetracycline-induced pleural injury in rabbits

“…Thus IPFT represents a less invasive and costly alternative to video-assisted thoracic surgery or other surgical interventions, which demonstrate comparable efficacy (16,44,45,58,60,71) in pediatric practice. IPFT also represents a preferred choice in high-risk (1, 22) and otherwise inoperable patients (10,43,49,56,57,69) or those with empyema/ loculation who refuse surgery. The reasons for the inconsistent results of IPFT in adult patients remain unclear but likely reflect the empiric approaches that are currently used.…”

Resistance to Co-Amoxiclav (Augmentin) in Community-Acquired and Nosocomial Pleural Infections

“…The authors speculated that changes in microorganisms, with perhaps more antibiotic resistance, might cause this increased mortality rate [10]. Accordingly, increased numbers of pleural infections due to Staphylococcus aureus [11,12], Streptococcus milleri [1], and Pseudomonas aeruginosa [11,13] was acknowledged.…”