Hospital-acquired thoracic empyema in adults: a 5-year study.
BACKGROUND
The objective of this study was to assess the etiology, microbiology and outcome of hospital-acquired thoracic empyema (HATE) in adults.


METHODS
From December 2001 to December 2006, 459 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were screened for HATE. HATE was defined as a new pleural empyema which developed after 48 hours of hospitalization.


RESULTS
In total, 56 adult (>or=18 years) patients who were diagnosed with HATE were enrolled in our series, including 35 men (62.5%) and 21 women (37.5%), with ages ranging from 22 to 87 years old (mean = 59). Causes of HATE were classified into two categories: hospital-acquired pneumonia (HAP) related (n = 25) and non-HAP related (n = 31). Causes of non-HAP related empyema were comprised of catheter-related infections (n = 20), hepatobiliary tract infections (n = 6), septic emboli (n = 4), and postpneumonectomy (n = 1). Comparing the bacteriology between the two categories, HAP-related empyema had a significantly higher incidence of aerobic Gram-negative organisms (76% vs. 38.7%, P = 0.005), polymicrobial pathogens (40% vs. 9.7%, P = 0.008), and anaerobic pathogens (20% vs. 0%, P = 0.009) than non-HAP related empyema. However, there was no significant difference in mortality rate (60% vs. 52%, P = 0.52) between the two categories.


CONCLUSIONS
Choice of antibiotic treatment for HATE should be based on the etiology of the pleural infection. In treating HAP-related empyema, antibiotics should cover aerobic Gram-negative, polymicrobial, and anaerobic pathogens.
Chen
Wei
W
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Lin
Yu-Chao
YC
Liang
Shinn-Jye
SJ
Tu
Chih-Yen
CY
Chen
Hung-Jen
HJ
Hang
Liang-Wen
LW
Hsu
Wu-Huei
WH
Shih
Chuen-Ming
CM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D003428:Cross Infection / Q000382:microbiology* / Q000401:mortality; D016724:Empyema, Pleural / Q000382:microbiology* / Q000401:mortality; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000382:microbiology* / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult