title: Predictive factors, microbiology and outcome of patients with parapneumonic effusion.
abstract: We aimed to determine the incidence, clinical consequences and microbiological findings related to the presence of pleural effusion in community-acquired pneumonia, and to identify predictive factors for empyema/complicated parapneumonic effusion. We analysed 4,715 consecutive patients with community-acquired pneumonia from two acute care hospitals. Patients were classified into three groups: no pleural effusion, uncomplicated parapneumonic effusion and empyema/complicated parapneumonic effusion. A total of 882 (19%) patients had radiological evidence of pleural fluid, of whom 261 (30%) met criteria for empyema/complicated parapneumonic effusion. The most important event related to the presence of uncomplicated parapneumonic effusion was a longer hospital stay. Relevant clinical and microbiological consequences were associated with empyema/complicated parapneumonic effusion. Five independent baseline characteristics could predict the development of empyema/complicated parapneumonic effusion: age < 60 yrs (p = 0.012), alcoholism (p = 0.002), pleuritic pain (p = 0.002), tachycardia >100 beats·min⁻¹ (p = 0.006) and leukocytosis >15,000 mm⁻³ (p < 0.001). A higher incidence of anaerobes and Gram-positive cocci was found in this subgroup of patients. We conclude that only the development of empyema/complicated parapneumonic effusion carried relevant consequences; this condition should be suspected in the presence of some baseline characteristics and managed by using antimicrobials active against Gram-positive cocci and anaerobes.
authors.affiliation: Internal Medicine, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Institut de recerca Biomèdia de Lleida (IRBLLEIDA), Lleida, Ciber de Enfermedades Respiratorias, Ciber, Spain. mfalguera@comll.cat
authors.forename: M
authors.initials: M
authors.lastname: Falguera
authors.forename: J
authors.initials: J
authors.lastname: Carratalà
authors.forename: S
authors.initials: S
authors.lastname: Bielsa
authors.forename: C
authors.initials: C
authors.lastname: García-Vidal
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-González
authors.forename: I
authors.initials: I
authors.lastname: Chica
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
authors.forename: J M
authors.initials: JM
authors.lastname: Porcel
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections; D016724:Empyema, Pleural / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents