title: Community-acquired thoracic empyema in older people.
abstract: OBJECTIVE
  To compare the clinical characteristics of community-acquired thoracic empyema in older and younger patients and to analyze the effect of various factors on outcome.
  
  
  METHODS
  A retrospective, comparative observational study.
  
  
  METHODS
  A university-affiliated tertiary medical center.
  
  
  METHODS
  Forty-six patients aged 65 and older (older group) and 86 patients aged 18 to 64 (younger group).
  
  
  METHODS
  Demographic, clinical, and microbiological data were reviewed.
  
  
  RESULTS
  Older patients were more likely to have dyspnea but less likely to have chest pain or fever (P<.05 for all). The causative organisms were similar between the two groups, with anaerobes and facultative streptococci the most common pathogens. Older patients had increased morbidity and longer hospital stay (median 29.5 vs 20 days, P<.001), but the in-hospital mortality was not significantly different between the two groups (13% vs 8%, P=.37). Multivariate analysis showed that coexisting malignancy (odds ratio (OR)=10.33, P=.01), lack of fever higher than 38 degrees C (OR=17.97, P=.03), and isolation of fungi from pleural fluid (OR=32.66, P=.01) were independently and significantly associated with in-hospital deaths.
  
  
  CONCLUSIONS
  The microbiology and mortality of community-acquired thoracic empyema were similar between the two age groups. Difference in chronological age did not explain in-hospital death. This finding highlights the importance of effective treatment to obtain better outcomes for older patients.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Tzu-Hsiu
authors.initials: TH
authors.lastname: Tsai
authors.forename: Jih-Shuin
authors.initials: JS
authors.lastname: Jerng
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Chen
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality; D016724:Empyema, Pleural / Q000382:microbiology / Q000401:mortality / Q000635:transmission*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome