Treatment Results and Prognostic Factors of Complicated Parapneumonic Effusion and Empyema

Kim, Young Joo; Ick, Seung; Kwon, Jee Suk; Yoo, Seung Soo; Jun, Hee Jung; Kim, Eun Jin; Kim, Chang Ho; Park, Jae Yong; Jung, Tae Hoon

doi:10.4046/trd.2007.63.1.24

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Unfortunately, few studies have evaluated pathogens of pleural infection in Korea [ 14 , 17 ]. In a study of adult patients with pleural infection, pathogens were isolated in 31 out of 115 cases; alpha-hemolytic streptococci were the most common pathogen in nine patients (26%), followed by Klebsiella pneumoniae in 8 patients (26%) and Staphylococcus aureus in 5 patients (16%) [ 14 ]. However, this study enrolled a small number of patients with identifiable pathogens, and culture were obtained from sputum and blood, in addition to pleural fluid [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Studies on pathogens and prognostic factors of pleural infection in adult patients in Asian countries have been reported [ 3 , 7 , 10 – 16 ], however, there are scarce studies in South Korea and these involve small numbers of subjects[ 14 , 17 ]. This study aimed to determine the microbiologic characteristics of pleural infection and to identify predictive factors associated with mortality.…”

Section: Introductionmentioning

confidence: 99%

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Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea

Park¹,

Oh²,

Choi³

et al. 2016

PLoS ONE

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BackgroundIdentification and understanding of the pathogens responsible for pleural infection is critical for appropriate antibiotic treatment. This study sought to determine the microbiological characteristics of pleural infection and to identify potential predictive factors associated with mortality.MethodsIn this retrospective study, we analyzed patient data from 421 cases of parapneumonic effusion. A total of 184 microorganisms were isolated from 164 patients, using two culture systems: a standard method and a method using pairs of aerobic and anaerobic blood culture bottles.ResultsThe most frequently isolated microorganisms were streptococci (31.5%), followed by staphylococci (23.4%), gram-negative bacteria (18.5%) and anaerobes (10.3%). Streptococci were the main microorganisms found in standard culture (41.9%) and community-acquired infections (52.2%), and were susceptible to all antimicrobial agents in drug sensitivity testing. Staphylococci were the most frequently isolated pathogens in blood cultures (30.8%) and hospital-acquired infections (38.3%), and were primarily multidrug-resistant (61.8%). In multivariate analysis, the following were significant predictive factors for 30-day mortality among the total population: CURB-65 ≥ 2 (aOR 5.549, 95% CI 2.296–13.407, p<0.001), structural lung disease (aOR 2.708, 95% CI 1.346–5.379, p = 0.004), PSI risk class IV-V (aOR 4.714, 95% CI 1.530–14.524, p = 0.007), no use of intrapleural fibrinolytics (aOR 3.062, 95% CI 1.102–8.511, p = 0.014), hospital-acquired infection (aOR 2.205, 95% CI 1.165–4.172, p = 0.015), age (aOR 0.964, 95% CI 0.935–0.994, p = 0.018), and SOFA score ≥2 (aOR 2.361, 95% CI 1.134–4.916, p = 0.022).ConclusionIn this study, common pathogens causing pleural infection were comparable to previous studies, and consisted of streptococci, staphylococci, and anaerobes. CURB-65 ≥2, structural lung disease, PSI risk class IV-V, no use of intrapleural fibrinolytics, hospital-acquired infection, older age, and SOFA score ≥ 2 are potential predictors of mortality in pleural infection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea

Park¹,

Oh²,

Choi³

et al. 2016

PLoS ONE

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“…Percutaneous catheter drainage (PCD) is the main interventional modality to decrease the amount of CPPE, however, this approach is not always successful owing to a thick layer of fibrin deposit and loculated nature of effusions. Therefore, intrapleural fibrinolytic treatment has been widely employed to lyse the fibrinous structures in pleural space [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Fibrinolysis with Lower Dose Urokinase in Patients with Complicated Parapneumonic Effusion

Lee

et al. 2021

Tuberc Respir Dis

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Background Intrapleural urokinase is one of the most widely used fibrinolytic agents in the treatment of complicated parapneumonic effusion (CPPE). However, little research has been performed on the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose urokinase. Methods We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at two tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatments as part of routine care. The primary outcome was the treatment success rate in the half dose urokinase group (50,000 IU daily for maximal 6 days) and the conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within one month. Results Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose urokinase. Both groups were relatively well matched at baseline, excluding higher serum white blood cell count and higher empyema prevalence in the half dose urokinase group. The treatment success rate was not different between the two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and indwelling catheter duration. In the multivariate analysis, urokinase dose was not a predictor of treatment success. Conclusion Half dose intrapleural urokinase is equally effective conventional dose urokinase in treating patients with CPPE or empyema.

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“…Unfortunately, few studies have evaluated pathogens of pleural infection in Korea. In a study for adult patients with pleural infection, pathogens were isolated in 31 of 115 cases of pleural infections; alpha-hemolytic streptococci was the most common pathogen in nine cases (26%) followed by Klebsiella pneumoniae in eight cases (26%), and Staphylococcus aureus in five cases (16%) 9 .…”

Section: Pathogens and Selection Of Antibioticsmentioning

confidence: 99%

Pleural Infection and Empyema

Kwon

2014

Tuberc Respir Dis

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Increasing incidence of pleural infection has been reported worldwide in recent decades. The pathogens responsible for pleural infection are changing and differ from those in community acquired pneumonia. The main treatments for pleural infection are antibiotics and drainage of infected pleural fluid. The efficacy of intrapleural fibrinolytics remains unclear, although a recent randomized control study showed that the novel combination of tissue plasminogen activator and deoxyribonuclease had improved clinical outcomes. Surgical drainage is a critical treatment in patient with progression of sepsis and failure in tube drainage.

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Treatment Results and Prognostic Factors of Complicated Parapneumonic Effusion and Empyema

Cited by 6 publications

References 26 publications

Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea

Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea

Fibrinolysis with Lower Dose Urokinase in Patients with Complicated Parapneumonic Effusion

Pleural Infection and Empyema

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