title: Community-acquired thoracic empyema in young adults.
abstract: BACKGROUND
  To evaluate the clinical characteristics, bacteriology, and therapeutic outcomes of community-acquired thoracic empyema (CATE) in young adults.
  
  
  METHODS
  From December 2000 to December 2005, 428 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were retrospectively reviewed. In total, there were 64 young adult patients who were diagnosed with CATE enrolled in our series, including 56 men (87.5%) and 8 women (12.5%). Ages ranged from 18 to 44 years old (mean = 37).
  
  
  RESULTS
  The most common underlying disease was alcoholism (28%), and the most common isolated microorganism was Viridans streptococci (27.3%). Among the 62 patients who underwent an invasive drainage procedure, 40 (64%) patients who received pigtail tube drainage as their initial treatment yielded a success rate of 70%. Fifteen (24%) patients who received video-assisted thoracoscopic surgery as first-line treatment yielded a success rate of 100%. To evaluate the risk factors for developing septic shock, we found that serum C-reactive protein (CRP) level on the first admission day (22.9 +/- 9.1 versus 13.2 +/- 8.1 mg/dL), presence of bacteremia (60 versus 13%), occurrence of polymicrobial infection (30 versus 5%) and inadequate antibiotic use (30 versus 7%) had statistical significance (P < 0.05).
  
  
  CONCLUSIONS
  Viridans streptococci was the most frequently isolated causative microorganism in young adults with CATE and alcoholism was the most common underlying disease. Moreover, a higher serum CRP level on the first day of admission, occurrence of bacteremia, presence of polymicrobial infection and inadequate antibiotic use were significant risk factors for developing septic shock.
authors.affiliation: Department of Internal Medicine, China Medical University Beigang Hospital, Taichung, Taiwan.
authors.forename: Shinn Jye
authors.initials: SJ
authors.lastname: Liang
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Yu-Chao
authors.initials: YC
authors.lastname: Lin
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Chen
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Tsai
authors.forename: Chuen-Ming
authors.initials: CM
authors.lastname: Shih
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000382:microbiology / Q000628:therapy*; D004322:Drainage; D016724:Empyema, Pleural / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000382:microbiology / Q000628:therapy; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D034363:Viridans Streptococci / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein