Analysis of Antibiotic Treatment and Microbiological Findings and Its Implication on Outcome in Patients with Parapneumonic Effusions
DOI:
https://doi.org/10.3889/oamjms.2024.11936Keywords:
uncomplicated parapneumonic effusion, complicated parapneumonic effusion, empyema, community-acquired pneumonia, antibiotic treatment, microbiology, length of hospitalizationAbstract
BACKGROUND: Parapneumonic effusion (PPE), as a complication of community-acquired pneumonia, sometimes progresses into complicated PPE (CPPE) and empyema, thus becoming a significant clinical problem. There is a lack of guidelines for antibiotic therapy and reports on local microbiological status and resistance of microorganisms.
AIM: Тhe paper is focused on the analysis of antibiotic therapy and microbiological findings that are affecting patient outcomes and length of treatment.
METHODS: We analyzed 94 patients, 50 with uncomplicated PPE (UCPPE) and 44 with CPPEs.
RESULTS: More patients (59.57%) were male, average age 53.82 ± 17.5 years. Alcoholism was the most common comorbidity in patients with CPPE registered in 25% of patients. A positive pleural punctate culture was present in 31.82% of patients with CPPE. Peptostreptococcus was most often isolated in 28.57%. Blood culture was positive in 12.76% of patients. Most of the patients were treated with combined therapy that also covered anerobes (64.89%). Statistical differences existed in terms of days of hospital treatment with a longer hospital stay for patients with CPPE (p < 0.0001). The average time of hospital treatment in patients with UCPPE was 15 days, and in patients with CPPE, it was 21 days.
CONCLUSION: As soon as a pleural infection is noted, patients should receive antibiotic therapy, which should be based on pleural fluid culture. Anerobic coverage is required. In this way, the development of CPPE and empyema will be prevented, and thus, mortality and long hospital stays will be reduced.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Tassi GF, Marchetti GP. Pleural disease: Historic perspective. In: Light RW, Lee YC, editors. Textbook of Pleural Diseases. 2nd ed. London: Hodder; 2008. p. 1-9.
Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3(1):75-80. https://doi.org/10.1513/pats.200510-113JH PMid:16493154
Hasley PB, Albaum MN, Li YH, Fuhrman CR, Britton CA, Marrie TJ, et al. Do pulmonary radiographic findings at presentation predict mortality in patients with community- acquired pneumonia? Arch Intern Med. 1996;156(19):2206-12. PMid:8885819
Girdhar A., Shujaat A, Bajwa A. Management of infectious processes of the pleural space: A review. Pulm Med. 2012;2012:816502. https://doi.org/10.1155/2012/816502 PMid:22536502
Hooper JW, Larsen T, Custer DM, Schmaljohn CS. A lethal disease model for hantavirus pulmonary syndrome. Virology. 2001;289(1):6-14. https://doi.org/10.1006/viro.2001.1133 PMid:11601912
Chapman SJ, Davies RJ. The management of pleural space infection. Respitology. 2004;9(1):4-11. https://doi.org/10.1111/j.1440-1843.2003.00535.x PMid:14982595
Mc Cauley L, Dean N. Pneumonia and empyema: Causal, casual or unknown. J Thorac Dis. 2015;7(6):992-8. https://doi.org/10.3978/j.issn.2072-1439.2015.04.36 PMid:26150912
Finich S, Chalmers JD. Parapneumonic effusions: Epidemiology and predictors of pleural. Infection Curr Respir Care Rep. 2014;3:52-60. https://doi.org/10.1007/s13665-014-0074-4
Koegelenberg CF, Diacon AH, Bolliger CT. Parapneumonic pleural effusion and empyema. Respiration. 2008;75(3):241-50. https://doi.org/10.1159/000117172 PMid:18367849
Smith JA, Mulleroworth MH, Westlake GW, Tatoulis J. Empyema thoracis: 14-year experience in a teaching center. Ann Thorac Surg. 1991;51(1):39-42. https://doi. org/10.1016/0003-4975(91)90443-t PMid:1985571
Rodríguez Suárez P, Freixinet Gilart J, Hernández Pérez JM, Hussein Serhal M, López Artalejo A. Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema. Med Sci Monit. 2012;18(7):CR443-9. https://doi.org/10.12659/msm.883212 PMid:22739734
Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, et al. Medical and surgical treatment of parapneumonic effusions: An evidence-based guideline. Chest. 2000;118(4):1158-71. https://doi.org/10.1378/chest.118.4.1158 PMid:11035692
Heffner JE. Indications for draining a parapneumonic effusion: An evidence-based approach. Semin Respir Infect. 1999;14(1):48-58. PMid:10197397
Foley SP, Parrish JS. Pleural space infections. Life (Basel). 2023;13(2):376. https://doi.org/10.3390/life13020376 PMid:36836732
Bedawi EO, Ricciardi S, Hassan M, Gooseman MR, Asciak R, Castro-Anon O, et al. ERS/ESTS statement on the management of pleural infection in adults. Eur Respir J. 2022;61(2):2201062. https://doi.org/10.1183/13993003.01062-2022 PMid:36229045
Davies HE, Davies RJ, Davies CW, BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British thoracic society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii41-53. https://doi.org/10.1136/thx.2010.137000 PMid:20696693
Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P, et al. The American association for thoracic surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017;153(6):e129-46. https://doi.org/10.1016/j.jtcvs.2017.01.030 PMid:28274565
Metlay JP, Waterer GW, LongAC,AnzuetoA, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American thoracic society and infectious diseases society of America. Am J Respir Crit Care Med. 2019;200(7):e45-67. https://doi.org/10.1164/rccm.201908-1581ST PMid:31573350
Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, et al. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352(9):865-74. https:// doi.org/10.1056/nejmoa042473. Erratum in: N Engl J Med. 2005;352(20):2146. PMid:15745977
Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med. 2023;49(6):615-32. https://doi.org/10.1007/ s00134-023-07033-8. Erratum in: Intensive Care Med. 2023;49(8):1040-1. https://doi.org/10.1007/s00134-023-07082-z PMid: 37012484
Djurić M, Djurić D, Ćulibrk T, Považan D. Parapneumonic effusions: Features, diagnostics and treatment options. Srp Arh Celok Lek. 2014;142(11-2):680-7. https://doi.org/10.2298/sarh1412680d PMid:25730997
Ozol D, Oktem S, Erdinc E. Complicated parapneumonic effusion and empyema thoracis: Microbiologic and therapeutic aspects. Respir Med. 2006;100(2):286-91. https://doi.org/10.1016/j. rmed.2005.05.018 PMid:15998584
Tsang KY, Leung WS, Chan VL, Lin AW, Chu CM. Complicated parapneumonic effusion and empyema thoracis: Microbiology and predictors of adverse outcomes. Hong Kong Med J. 2007;13(3):178-86. PMid:17548905
Chalmers JD, Singanayagam A, Murray MP, Scally C, Fawzi A, Hill AT. Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax. 2009;64(7):592-7. https://doi.org/10.1136/thx.2008.105080 PMid:19131449
Gupta NM, Deshpande A, Rothberg MB. Pneumonia and alcohol use disorder: Implications for treatment. Cleve Clin J Med. 2020;87(8):493-500. https://doi.org/10.3949/ccjm.87a.19105. PMid:32737050.
Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis. 2007;45(11):1480-6. https://doi.org/10.1086/522996 PMid:17990232
Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: Past, present, and future directions. Lancet Respir Med. 2015;3(7):563-77. https://doi.org/10.1016/S2213-2600(15)00185-X Mid:26170076
Brims FJ, Lansley SM, Waterer GW, Lee YC. Empyema thoracis: New insights into an old disease. Eur Respir Rev. 2010;19(117):220-8. https://doi.org/10.1183/09059180.00005610 PMid:20956197
Vaziri M, Abed O. Management of thoracic empyema: Review of 112 cases. Acta Med Iran. 2012;50(3):203-7. PMid:22418990
Menzies SM, Rahman NM, Wrightson JM, Davies HE, Shorten R, Gillespie SH, et al. Blood culture bottle culture of pleural fluid in pleural infection. Thorax. 2011;66(8):658-62. https://doi.org/10.1136/thx.2010.157842 PMid:21459855
Sundaralingam A, Banka R, Rahman NM. Management of pleural infection. Pulm Ther. 2021;7(1):59-74. https://doi.org/10.1007/s41030-020-00140-7 PMid:33296057
Villena Garrido V, Ferrer Sancho J, Hernández Blasco L, De Pablo Gafas A, Pérez Rodríguez E, Rodríguez Panadero F, et al. Diagnóstico y tratamiento del derrame pleural [Diagnosis and treatment of pleural effusion]. Arch Bronconeumol. 2006;42(7):349-72. https://doi.org/10.1016/s1579-2129(06)60545-4 PMid:16945266
Hassan M, Cargill T, Harriss E, Asciak R, Mercer RM, Bedawi EO, et al. The microbiology of pleural infection in adults: A systematic review. Eur Respir J. 2019;54(3):1900542. https:// doi.org/10.1183/13993003.00542-2019 PMid:31248959
Avner BS, Ginosyan A, Le J, Mak J, Qiryaqoz Z, Huffman C. Analysis of antibiotic use and clinical outcomes in adults with known and suspected pleural empyema. BMC Infect Dis. 2022;22(1):783. https://doi.org/10.1186/s12879-022-07759-8 PMid:36224539
Falguera M, Carratalà J, Bielsa S, García-Vidal C, Ruiz- González A, Chica I, et al. Predictive factors, microbiology and outcome of patients with parapneumonic effusion. Eur Respir J. 2011;38(5):1173-9. https://doi.org/10.1183/09031936.00000211 PMid:21565916
Lim TK. Management of parapneumonic pleural effusion. Curr Opin Pulm Med. 2001;7(4):193-7. https://doi. org/10.1097/00063198-200107000-00005 PMid:11470973
San José ME, Ferreiro L, Soneira ME, González- Barcala FJ, Vázquez MC, Golpe A, et al. Utility of measurement of interleukin-1ß and interleukin-8 in the diagnosis of complicated parapneumonic pleural effusions. Am J Clin Pathol. 2014;142(4):467-73. https://doi.org/10.1309/AJCPDC7PS8TIPBXP PMid:25239413
Light RW, Rodriguez RM. Management of parapneumonic effusions. Clin Chest Med. 1998;19(2):373-82. https://doi.org/10.1016/s0272-5231(05)70084-8 PMid:9646988
Downloads
Published
How to Cite
License
Copyright (c) 2024 Sanja Petrusevska-Marinkovic (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)
