Predictors of Outcome and Long-term Survival in Patients with Pleural Infection

Abstract

In pleural infection, medical treatment failure (chest-tube drainage and antibiotics) requires surgery and increases mortality. It would be helpful to predict which patients will fail this approach. We examined clinical predictors in 85 consecutive patients with pleural infection receiving chest drainage and intrapleural fibrinolytics, and recorded age, length of history, antibiotic delay and choice, time to drainage, blood/pleural fluid (PF) bacteriology, PF pH, lactate dehydrogenase (LDH), glucose and appearance, effusion size, pleural thickness on computed tomographic (CT) scan, and survival from time of drainage. Failures (surgery/death) were compared with successes. There were 13 (15%) medical failures. PF purulence was more frequent in medical failures (10 of 13 versus 29 of 72 successes, p < 0.02 chi-square). Absence of purulence was a useful predictor of success (positive predictive value [PPV] 93%). Purulence was not useful in predicting medical failure (PPV 26%). There was a trend for positive blood culture to predict failure (5 of 13 failures versus 11 of 72 successes, p = 0.05 chi-square), but no significant differences in other endpoints. Twelve (14%) patients died in follow-up, all with comorbidity within 400 d after drainage. Probability of survival at 4 yr was 86%. Of endpoints considered in this study, PF purulence was the only useful predictor of outcome with medical therapy in pleural infection. There is good long-term survival from pleural infection.

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

“…Subjects were admitted in our ICU if chest tube drainage was needed. Though, our subjects did not represent a real ICU population with subsequent elevated mortality, but is in agreement with previous reports accounting for by mortality rates of about 4.7% to 27%, in patients with complicated pleural effusions [5,15,17]. Maskell found a 12-month mortality rate of about 22%, with a significant increase in patients with nosocomial infections (45%; OR 4.24), the mortality rates increased when S. aureus, GNB, or mixed aerobic bacteria where found, compared to anaerobes, Streptococcal, or culture-negative infections [6].…”

“…PF had different characteristics than previous studies [6,17,20]. PF pH and glucose were higher, though, false positive of PF culture might account for misdiagnosis.…”

“…Though, their susceptibility to antibiotics antimicrobial therapy might have been even lower than ours. Finally, in contrast with lung infection [18], delay in adequate antimicrobial therapy in PF may not be the point [17], as chest tube drainage is an effective treatment to quickly decrease bacterial load and improve the patients' condition [19][20][21]. However, some authors recommend not draining every complicated pleural effusion [22].…”

“…Moreover, every subject had clinical signs of overt pleural infection in our series. Clinicians should take into account PF culture despite elevated PF pH and glucose, if clinically indicated [17].…”

Outcome and mortality analysis in complicated parapneumonic effusion and empyema

“…In a series of 85 patients followed for up to 4 years, the mortality was 14% and all deaths occurred within the first 400 days after drainage. 39 Death was due to comorbid condition and not directly due to sepsis from the empyema. No reliable clinical, radiological or pleural fluid characteristics accurately determine patient's prognosis at initial presentation.…”