The changing pathogens of complicated parapneumonic effusions or empyemas in a medical intensive care unit.
OBJECTIVE
To assess the incidence, pathogens, and outcome of complicated parapneumonic effusions or empyemas in a medical intensive care unit (MICU) patients with pleural effusions.


METHODS
Prospective study of febrile MICU patients with pleural effusion carried out in a tertiary care hospital between April 2001 and September 2003.


METHODS
The study included 175 patients with a temperature above 38 degrees for more than 8 h with evidence of pleural effusion confirmed by chest radiography and ultrasound.


METHODS
Routine thoracentesis and effusion cultures.


RESULTS
The prevalence of complicated parapneumonic effusions or thoracic empyemas in febrile MICU patients with pleural effusions was 45% (78/175). A total of 78 micro-organisms were isolated from the pleural fluid of 58 patients (positive microbiological culture 74%) including aerobic Gram-negative (n=45), aerobic Gram-positive (n=23), anaerobic (n=5), Myobacterium tuberculosis (n=3), and Candida (n=2). The infection-related mortality rate of complicated parapneumonic effusions or empyemic patients in the MICU was 41% (32/78).


CONCLUSIONS
The development of complicated parapneumonic effusions or thoracic empyemas in MICU patients is a high-mortality disease. The increasing incidence of aerobic Gram-negative pathogens in empyema has become a more urgent problem.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Chih-Yen
CY
Tu
Wu-Huei
WH
Hsu
Te-Chun
TC
Hsia
Hung-Jen
HJ
Chen
Kuo-Liang
KL
Chiu
Liang-Wen
LW
Hang
Chuen-Ming
CM
Shih
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D001432:Bacteriology; D016724:Empyema, Pleural / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006088:Gram-Negative Aerobic Bacteria / Q000472:pathogenicity; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology