title: A comparative study of community- and nursing home-acquired empyema thoracis.
abstract: OBJECTIVE
  To compare the clinical presentation, microbiological features, and outcomes of patients with community-acquired empyema (CAE) with those of patients with nursing home-acquired empyema (NHAE).
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  Three tertiary care centers.
  
  
  METHODS
  One hundred fourteen patients admitted from the community and 55 patients transferred from nursing homes.
  
  
  METHODS
  Baseline sociodemographic information, activities of daily living, Charlson Comorbidity Index score, and clinica, and microbiologic data were obtained. Outcome was assessed at hospital discharge and 6 months postdischarge.
  
  
  RESULTS
  Patients admitted from nursing homes had a delayed presentation, with dyspnea, weight loss, and anemia as the predominant manifestation. Patients with CAE presented more acutely, with fever, cough, and chest pain. Anaerobic organisms were more commonly isolated from patients with NHAE. The success rate of nonsurgical intervention was significantly lower for the NHAE patients than for the CAE group (39% vs 63; P=.01). In-hospital mortality was not significantly different between the two groups (NHAE, 18%; CAE, 8%; P=.09). In a Cox regression analysis, preadmission functional status (hazard ratio (HR)=1.26, 95% confidence interval (CI)=1.19-1.4; P<.001) and surgical intervention (HR=0.47, 95% CI=0.24-0.92; P=.03) were the only variables highly correlated with long-term outcome.
  
  
  CONCLUSIONS
  Patients admitted with NHAE have distinctly different clinical and microbiological presentation from that of patients with CAE. Because of the delayed presentation in patients with NHAE, medical treatment alone may be associated with higher rate of failure. Surgical therapy should be considered for selected cases, with the aim of improving long-term survival.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Western New York Respiratory Research Center, Buffalo, New York, USA. solh@buffalo.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: El Solh
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alhajjhasan
authors.forename: Fadi H
authors.initials: FH
authors.lastname: Ramadan
authors.forename: Lilibeth A
authors.initials: LA
authors.lastname: Pineda
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D001431:Bacteriological Techniques; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009518:New York; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality