title: Complicated parapneumonic effusion and empyema thoracis: microbiology and predictors of adverse outcomes.
abstract: OBJECTIVE
  To describe the microbiological characteristics of a cohort of patients with complicated parapneumonic effusion and empyema thoracis, and to identify the potential risk factors for adverse outcomes, with particular reference to the choice of empirical antibiotics, intrapleural fibrinolytics, adherence to management guidelines, and input from pulmonologists.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Regional hospital, Hong Kong.
  
  
  METHODS
  All patients with a diagnosis of complicated parapneumonic effusion/empyema thoracis admitted between January 2003 and June 2005.
  
  
  METHODS
  Microbiological characteristics, mortality, and surgery-free survival. RESULTS. There were 63 patients, with a mean age of 64 (standard deviation, 16) years and a male-to-female ratio of 45:18. The pleural fluid culture positivity rate was 68%; Streptococcus milleri (19%), Bacteroides (14%), Klebsiella pneumoniae (12%), and Peptostreptococcus (7%) were the most common organisms. Thirteen (21%) patients died during their index admission. Use of intrapleural fibrinolytics according to the guideline was associated with survival (P=0.001) while discordant initial antibiotic use was associated with mortality (P=0.002). Discordant initial antibiotic use was also independently associated with reduced surgery-free survival (P<0.001). Subgroup analysis showed that early intrapleural fibrinolytic use (within 4 days of diagnosis) was associated with decreased mortality (P<0.001), increased surgery-free survival (P=0.005), and shorter hospital stay (P=0.039).
  
  
  CONCLUSIONS
  Organisms identified from complicated parapneumonic effusion and empyema thoracis differ from those giving rise to community-acquired pneumonia. In these patients, adherence to guidelines, early concordant antibiotic treatment, intrapleural fibrinolytics, and input from a pulmonologist were associated with improved outcomes.
authors.affiliation: Division of Infectious Disease, Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
authors.forename: K Y
authors.initials: KY
authors.lastname: Tsang
authors.forename: W S
authors.initials: WS
authors.lastname: Leung
authors.forename: Veronica L
authors.initials: VL
authors.lastname: Chan
authors.forename: Alsa W L
authors.initials: AW
authors.lastname: Lin
authors.forename: C M
authors.initials: CM
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001439:Bacteroides / Q000187:drug effects / Q000302:isolation & purification; D017723:Drug Utilization Review; D016724:Empyema, Pleural / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use; D019983:Guideline Adherence; D006723:Hong Kong; D017052:Hospital Mortality; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D010462:Peptostreptococcus / Q000187:drug effects / Q000302:isolation & purification; D010996:Pleural Effusion / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D034364:Streptococcus milleri Group / Q000187:drug effects / Q000302:isolation & purification; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents