title: A 30-month experience of thoracic empyema in a tertiary hospital: emphasis on differing bacteriology and outcome between the medical intensive care unit (MICU) and medical ward.
abstract: OBJECTIVE
  To analyze the causative pathogens and outcomes of patients with thoracic empyema admitted to the medical intensive care unit (MICU) and medical ward.
  
  
  METHODS
  We prospectively studied the empyemic patients in the MICU and retrospectively analyzed the medical records of empyemic patients in the medical ward treated in a tertiary university hospital from April 2001 to September 2003.
  
  
  RESULTS
  During this period, 116 patients in the medical ward and 78 patients in MICU had complicated parapneumonic effusions or empyemas. Effusion cultures were positive in 164 patients (85%); a total of 147 and 78 microorganisms were isolated from the 106 medical ward patients and 58 MICU patients, respectively. No matter whether medical ward or MICU patients, aerobic gram-negative organisms were the most common bacteria in positive-culture effusions (110, 67%). Klebsiella pneumoniae (14, 24%) was the predominant pathogen among the MICU patients, and Streptococcus spp. (28, 26%) was the main pathogen among the medical ward patients. Compared with these positive-culture empyemic patients in the medical ward, MICU patients had a significantly higher percentage of aerobic gram-negative organism infections (P = 0.034) and a higher infection-related mortality rate (P = 0.01).
  
  
  CONCLUSIONS
  The mortality and predominant pathogens in patients with complicated parapneumonic effusions or thoracic empyemas in the medical ward and MICU were different. The increasing gram-negative pathogens in empyemas have become an urgent problem.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Yu-Chao
authors.initials: YC
authors.lastname: Lin
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Chen
authors.forename: Yi-Heng
authors.initials: YH
authors.lastname: Liu
authors.forename: Chuen-Ming
authors.initials: CM
authors.lastname: Shih
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
mesh_terms: D000368:Aged; D016724:Empyema, Pleural / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013907:Thoracostomy