1
|
Chan KP, Ng SSS, Ling KC, Ng KC, Lo LP, Yip WH, Ngai JCL, To KW, Ko FWS, Lee YCG, Hui DSC. Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study. ERJ Open Res 2023; 9:00534-2022. [PMID: 37020833 PMCID: PMC10068520 DOI: 10.1183/23120541.00534-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/22/2022] [Indexed: 01/27/2023] Open
Abstract
Background The clinical impact of phenotyping empyema is poorly described. This study was designed to evaluate clinical characteristics and outcomes based on the two readily available parameters, pleural fluid culture status and macroscopic fluid appearance. Methods A retrospective study was conducted on patients with empyema hospitalised between 2013 and 2020. Empyema was classified into culture-positive empyema (CPE) or culture-negative empyema (CNE) and pus-appearing empyema (PAE) or non-pus-appearing empyema (non-PAE) based on the pleural fluid culture status and macroscopic fluid appearance, respectively. Results Altogether, 212 patients had confirmed empyema (CPE: n=188, CNE: n=24; PAE: n=118, non-PAE: n=94). The cohort was predominantly male (n=163, 76.9%) with a mean age of 65.0±13.6 years. Most patients (n=180, 84.9%) had at least one comorbidity. Patients with CPE had higher rates of in-hospital mortality (19.1% versus 0.0%, p=0.017) and 90-day mortality (18.6% versus 0.0%, p=0.017) and more extrapulmonary sources of infection (29.8% versus 8.3%, p=0.026) when compared with patients with CNE. No significant difference in mortality rate was found between PAE and non-PAE during the in-hospital stay and at 30 days and 90 days. Patients with PAE had less extrapulmonary sources of infection (20.3% versus 36.2%, p=0.010) and more anaerobic infection (40.9% versus 24.5%, p=0.017) than those with non-PAE. The median RAPID (renal, age, purulence, infection source, and dietary factors) scores were higher in the CPE and non-PAE groups. After adjusting for covariates, culture positivity was not independently associated with mortality on multivariable analysis. Conclusion Empyema is a heterogeneous disease with different clinical characteristics. Phenotyping empyema into different subclasses based on pleural fluid microbiological results and macroscopic fluid appearance provides insight into the underlying bacteriology, source of infection and subsequent clinical outcomes.
Collapse
Affiliation(s)
- Ka Pang Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Susanna So Shan Ng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Kwun Cheung Ling
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Ka Ching Ng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Lai Ping Lo
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Wing Ho Yip
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Jenny Chun Li Ngai
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Kin Wang To
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Yun Chor Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - David Shu Cheong Hui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| |
Collapse
|
2
|
Bedawi EO, Hassan M, McCracken D, Rahman NM. Pleural infection: a closer look at the etiopathogenesis, microbiology and role of antibiotics. Expert Rev Respir Med 2019; 13:337-347. [PMID: 30707629 DOI: 10.1080/17476348.2019.1578212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pleural infection is a condition that continues to pose a significant challenge to respiratory physicians. We hypothesize that the main barriers to progress include limited understanding of the etiopathogenesis, microbiology,and role of antibiotics in the pleural space. Areas covered: PubMed was searched for articles related to adult pleural infection using the terms 'pleural infection', 'empyema' and 'parapneumonic'. The search focused on relevant literature within the last 10 years, with any older citations used only to display context or lack of progress. Tuberculous pleural infection was excluded. We chose to give specific attention to the etiopathogenesis of pleural infection, including recent advances in diagnostics and biomarkers. We discuss our understanding of the pleural microbiome and rationalize the current use of antibiotics in treating this condition. Expert commentary: Understanding of key events in the development of this condition remains limited. The microbiology is unique compared to the lung, and highly variable. Higher culture yields from pleural biopsy may add new insights into the etiopathogenesis. There is little evidence into achievable effective antibiotic concentration within the pleura. Research into issues including the relevance of biofilm formation and significance of pleural thickening is necessary for treatment progress.
Collapse
Affiliation(s)
- Eihab O Bedawi
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK
| | - Maged Hassan
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK.,c Chest Diseases Department, Faculty of Medicine , Alexandria University , Alexandria , Egypt
| | - David McCracken
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK
| | - Najib M Rahman
- a Oxford Pleural Unit , Oxford University Hospitals , Oxford , UK.,b Oxford Respiratory Trials Unit , University of Oxford , Oxford , UK.,d Oxford NIHR Biomedical Research Centre , Oxford , UK
| |
Collapse
|