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Cheng YF, Chen CM, Chen YL, Cheng CY, Huang CL, Hung WH, Wang BY. The outcomes of thoracoscopic decortication between fungal empyema and bacterial empyema. BMC Infect Dis 2023; 23:8. [PMID: 36609233 PMCID: PMC9817236 DOI: 10.1186/s12879-022-07978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Fungal empyema is an uncommon disease and is associated with a high mortality rate. Surgical intervention is suggested in stage II and III empyema. However, there were no studies that reported the outcomes of surgery for fungal empyema. METHODS This study is a retrospective analysis in a single institute. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. We separated the patients into a fungal empyema group and a bacterial empyema group according to culture results. We used 1:3 propensity score matching to reduce selection bias. RESULTS There were 1197 empyema patients who received surgery. Of these, 575 patients showed positive culture results and were enrolled. Twenty-eight patients were allocated to the fungal empyema group, and the other 547 patients were placed in the bacterial empyema group. Fungal empyema showed significantly longer intensive care unit stay (16 days vs. 3 days, p = 0.002), longer median ventilator usage duration (20.5 days vs. 3 days, p = 0.002), longer hospital stay duration (40 days vs. 17.5 days, p < 0.001) and a higher 30-day mortality rate (21.4% vs. 5.9%, p < 0.001). Fungal empyema revealed significantly poorer 1-year survival rate than bacterial empyema before matching (p < 0.001) but without significant difference after matching. CONCLUSIONS The fungal empyema patients had much worse surgical outcomes than the bacterial empyema patients. Advanced age and high Charlson Comorbidity Index score are independent predictors for poor prognosis. Prompt surgical intervention combined with the use of antifungal agents was the treatment choice for fungal empyema.
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Affiliation(s)
- Ya-Fu Cheng
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Chun-Min Chen
- grid.413814.b0000 0004 0572 7372Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yi-Ling Chen
- grid.413814.b0000 0004 0572 7372Surgery Clinical Research Center, Changhua Christian Hospital, Changhua City, Taiwan
| | - Ching-Yuan Cheng
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Chang-Lun Huang
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Wei-Heng Hung
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan
| | - Bing-Yen Wang
- grid.413814.b0000 0004 0572 7372Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500 Changhua City, Taiwan ,grid.260542.70000 0004 0532 3749Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan ,grid.411641.70000 0004 0532 2041School of Medicine, Chung Shan Medical University, Taichung, Taiwan ,grid.412019.f0000 0000 9476 5696School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ,grid.260542.70000 0004 0532 3749Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan ,Center for General Education, Ming Dao University, Changhua City, Taiwan
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Shekhar H, Sharma N, Singh SK, Garg PK, Bhatt S, Saha R, Verma AK. Clinico-radiological profile of the patients with empyema thoracis: A prospective analytical study. Indian J Tuberc 2021; 68:491-496. [PMID: 34752319 DOI: 10.1016/j.ijtb.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/07/2020] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Empyema thoracis is defined as the presence of pus in the pleural cavity and carries significant morbidity and mortality. This study aimed to explore the demographic and clinico-radiological characteristics of patients with empyema thoracis. MATERIAL AND METHODS The present study was conducted in a tertiary care teaching hospital in North India. The patients diagnosed with empyema thoracis were included in the study. Demographic, etiologic, clinical, radiographic, and outcome data were prospectively collected and analyzed. RESULTS The study included 48 patients. The median age of empyema thoracis patients was 37(IQR 26-45) years. Common presenting symptoms were breathlessness (n = 37,77%) and chest pain (n = 34,70%). Contrast-enhanced computed tomography (CECT) of the chest showed type III empyema in 52% (21) patients followed by type 1 and type II in 25% and 22%, respectively. CECT thorax showed the collapse of lung and consolidation in (n = 28, 70%) and (n = 24, 60%) patients, respectively. All the patients, except for one, were managed with underwater seal intercostal tube drainage (ICD) procedure for the management of empyema. The median time to remove the ICD tube among 35 patients was 14 (IQR 9-21) days. Forty patients (83.3%) responded to the treatment and were discharged. Eight patients (16.7%) deteriorated and succumbed to the disease. CONCLUSION Patients of empyema thoracis required a prolonged period of chest tube drainage and carried significant morbidity and mortality.
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Affiliation(s)
- Himanshu Shekhar
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Saurabh Kumar Singh
- Department of Respiratory Medicine, Gajra Raja Medical College and Jayarogya Group of Hospitals, Gwalior, Madhya Pradesh, 474009.
| | - Pankaj Kumar Garg
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Shuchi Bhatt
- Department of Radiodiagnosis, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India
| | - Rumpa Saha
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India
| | - Amit Kumar Verma
- Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India
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Warnow IE, Ayoola YA, Daniel A, Raymond MP, Abubakar ML, Adeniji RY, Joel Z, Abdulkarim H, Manga M, Okolie HI. Citrobacter freundii: A Cause of Cardiac Tamponade and Empyema Thoracis in a Nigerian Child. J Cardiovasc Echogr 2020; 30:121-123. [PMID: 33282654 PMCID: PMC7706380 DOI: 10.4103/jcecho.jcecho_4_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/18/2020] [Accepted: 05/21/2020] [Indexed: 11/04/2022] Open
Abstract
Citrobacter infection is an uncommon but serious, difficult to treat infection associated with high mortality. Accumulation of pus or fluid in a pericardial space causes restriction of cardiac filling and consequent decrease in cardiac output. We herein report Citrobacter freundii, a rare infectious cause of this uncommon disorder. Our patient is a 10yr old male referred with complaints of cough productive of mucoid sputum and associated chest pain of two weeks duration, difficulty in breathing and orthopnoea for one week. He was acutely ill looking in respiratory distress with tachypnoea and tachycardia. Blood pressure was normal with pulsus alternans, there was increased jugular venous pressure, diffused apex beat and distant heart sounds with pericardial rub. Retroviral screening and gene Xpert for Mycobacterium tuberculosis were negative. Chest radiograph showed enlarged heart of "water bottle" appearance with cardiothoracic ratio of 0.77 and right sided pleural effusion which was drained. Transthoracic Echocardiogram confirm pyopericardium with multiples echoes in cardiac temponade. Echo-guided percutaneous pericardiocentesis yielded 600mls of purulent aspirates. Citrobacter freundii Sensitive to gentamycin, co-amoxiclav but resistant to cefuroxime and cefixime was cultured from pericardial aspirates and sputum. Patient recovered fully after pericardiocentesis and intravenous antibiotics. In this case report, we describe Citrobacter freundii causing cardiac temponade and empyema in a Nigerian immunocompetent child which to our knowledge has thus far not been reported. Pyopericardium may follow rare causes as Citrobacter freundii which require high index of suspicion.
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Affiliation(s)
- Isaac Elon Warnow
- Department of Paediatrics, Federal Teaching Hospital, Gombe, Nigeria
| | | | - Apollos Daniel
- Department of Paediatrics, Federal Teaching Hospital, Gombe, Nigeria
| | | | | | | | - Zwabragi Joel
- Department of Paediatrics, Federal Teaching Hospital, Gombe, Nigeria
| | - Halima Abdulkarim
- Department of Paediatrics, Federal Teaching Hospital, Gombe, Nigeria
| | - Muhammad Manga
- Department of Medical Microbiology, Gombe State University, Gombe, Nigeria
| | - Henry I Okolie
- Department of Medicine, Federal Teaching Hospital, Gombe, Nigeria
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Pulle MV, Puri HV, Asaf BB, Bishnoi S, Malik M, Kumar A. Predictors of Mortality after Surgery for Empyema Thoracis in Chronic Kidney Disease Patients. Korean J Thorac Cardiovasc Surg 2020; 53:392-399. [PMID: 33234767 PMCID: PMC7721523 DOI: 10.5090/kjtcs.20.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
Background Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predicting perioperative mortality in patients with chronic kidney disease. Methods This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2 for 3 or more months) who underwent surgery for empyema between 2012 and 2020. An analysis of demographic characteristics and perioperative variables, including complications, was carried out. Postoperative mortality was the primary outcome measure. Results Patients' age ranged from 20 to 74 years with a 29-to-5 male-female ratio. The majority (n=19, 55.9%) of patients were in end-stage renal disease (ESRD) requiring maintenance hemodialysis. The mean operative time was 304 minutes and the mean intraoperative blood loss was 562 mL. Postoperative morbidity was observed in 70.5% of patients (n=24). In the subgroup analysis, higher values for operative time, blood loss, intensive care unit stay, and complications were found in ESRD patients. The mortality rate was 38.2% (n=13). In the univariate and multivariate analyses, poor performance status (Eastern Cooperative Oncology Group >2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. Conclusion ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.
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Affiliation(s)
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Malik
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Baral S, Chhetri RK, Gyawali M, Thapa N. Splenic abscess complicated by pleural empyema: A rare case report from rural Nepal. Int J Surg Case Rep 2020; 75:492-496. [PMID: 33076203 PMCID: PMC7530217 DOI: 10.1016/j.ijscr.2020.09.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/19/2020] [Indexed: 12/03/2022] Open
Abstract
Splenic abscess is one of the rarer findings which is commonly seen in immunocompromised individuals. Splenic abscess may present with features of pleural effusion along with empyema if gets infected. Pleural empyema needs tube drainage. Splenic entity if unilocular, can be managed with broad spectrum antibiotics along with percutaneous aspiration or drainage. Open drainage or splenectomy is mandatory in case percutaneous techniques fail.
Introduction Splenic abscess generally occurs through hematogenous spread and typically follows endocarditis or seeding from contiguous sites of infection. This can be complicated by empyema thoracis. We present a rarer case of chronic alcoholic with splenic abscess along with empyema thoracis. Presentation of a case A 39-year old alcoholic male presented with history of pain at left hypochondrium and difficulty breathing for 7 days. Abdominal examination revealed tenderness at left hypochondrium along with enlarged spleen and liver associated with decreased air entry of left chest. Chest X-ray showed complete white out lung field on left side. Contrast enhanced tomography abdomen and pelvis revealed splenic abscess involving lower pole of spleen along with peri splenic extension. Tube thoracostomy drainage on left chest was done followed by ultrasonography guided repeated aspiration of splenic entity. Pus culture sensitivity showed growth of Streptococcus pyogenes while splenic aspirate remained sterile. Patient got discharged on 8th day of admission with full recovery. Discussion Splenic abscess is the rare entity which is commonly seen in immunocompromised individuals that might get complicated as empyema thoracis and management includes broad spectrum antibiotics along with tube thoracostomy and percutaneous drainage of splenic abscess if possible, in view of spleen being salvageable. Pleural collection revealed growth of Streptococcus pyogenes in our case which itself is the rare finding. Conclusion Splenic abscess can be managed with percutaneous aspiration/drainage if lesion is unilocular in the view of salvaging spleen. Complicated empyema can be managed with tube thoracostomy along with broad spectrum antibiotics.
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Affiliation(s)
- Suman Baral
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| | - Raj Kumar Chhetri
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| | - Milan Gyawali
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
| | - Neeraj Thapa
- Department of Surgery, Lumbini Medical College and Teaching Hospital Ltd, Tansen-7, Pravas, Palpa, Nepal.
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Das NN, Lakhotia S, Verma A. Surgical outcome of empyema thoracis patients with special correlation to pre-operative contrast-enhanced computerized tomography (CECT) thorax morphometry. Indian J Thorac Cardiovasc Surg 2020; 37:164-174. [PMID: 33642714 DOI: 10.1007/s12055-020-01053-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Empyema thoracis is a very common disease. The surgical outcome of empyema patients depends upon various factors. To the best of our knowledge, there is no study in literature describing the surgical outcome of patients in relation to the contrast-enhanced computerized tomography (CECT) thorax morphometric findings. In this study, we examined the surgical outcome of empyema thoracis patients in relation to both clinical and radiological findings. Materials and methods It is a prospective hospital-based study conducted between October 2016 and August 2018. A total of 30 patients, who underwent decortication during the study period, were included. They were divided into three performance groups (excellent performance, average performance and poor performance groups) according to the outcome. The surgical outcome was correlated with the pre-operative clinical, radiological, intra-operative and post-operative parameters. Results Intra-operative ability to complete decortication, intra-operative expansion of the lungs and presence of broncho-pleural fistula were significantly different between the three performance groups. Duration of the disease, pre-operative duration of antitubercular therapy (ATT) intake and duration of pre-operative intercostal drain (ICD) were statistically insignificant between groups. In computed tomography (CT) morphometry, residual lung volume of the involved lung and volume of empyema were found to be significantly different between the performance groups. The residual volume of the involved lung (expressed in terms of the percentage of lung volume of the normal opposite lung) can predict the complete expansion of the lung with sensitivity of 71% and specificity of 70%. Conclusion The pre-operative residual lung volume of the involved lung, empyema volume, completeness of decortication, intra-operative expansion of the lung and presence or absence of broncho-pleural fistula can determine the surgical outcome in empyema thoracis patients.
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Affiliation(s)
- Narendra Nath Das
- Department of CTVS, Institute of Medical Sciences, BHU, Varanasi, India
| | | | - Ashish Verma
- Department of Radio Diagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi, India
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Abstract
BACKGROUND/PURPOSE The success rate of early thoracoscopic debridement (TD) for childhood empyema was reviewed in light of the increasing reported incidence of empyema associated with pulmonary necrosis (PN). METHODS Data were collected from 106 patients who underwent thoracoscopic intervention from 2010 to 2016. Twenty additional patients with severe PN/Bronchopleural Fistula (BPF) were not suitable for TD requiring thoracotomy and Serratus anterior digitation flap. RESULTS 106 patients with a median age of 4 years (IQR 2-6 years) were considered for TD as primary intervention of which 3 needed conversion to thoracotomy. TD alone was successful in 93/106 however, 10 patients required subsequent minithoracotomy for PN/BPF (managed with Serratus anterior digitation flap). Counting conversions as failure, the overall success rate of TD was 88%. No statistical difference was demonstrable in success rate compared to our previous series (93% (106/114) vs 88% (93/106)). CONCLUSIONS Primary TD in pediatric empyema is associated with an excellent outcome achieving adequate drainage and full expansion of the lung. The majority of failures in our series were attributable to PN/BPF, requiring thoracotomy and Serratus anterior digitation flap. This is likely a consequence of the increasing incidence of necrotizing pneumonia. LEVEL OF EVIDENCE Level IV.
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Reichert M, Pösentrup B, Hecker A, Schneck E, Pons-Kühnemann J, Augustin F, Padberg W, Öfner D, Bodner J. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients. Surg Endosc 2017; 32:2664-2675. [PMID: 29218675 DOI: 10.1007/s00464-017-5961-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pleural empyema is an infectious disease of the chest cavity, with a high morbidity and mortality. According to the American Thoracic Society, pleural empyema gets graduated into three stages, with surgery being indicated in intermediate stage II and chronic stage III. Evidence for the feasibility of a minimally-invasive video-assisted thoracoscopic approach in stage III empyema for pulmonary decortication is still little. METHODS Retrospective single-center analysis of patients conducted to surgery for chronic stage III pleural empyema from 05/2002 to 04/2014 either by video-assisted thoracoscopic surgery (VATS, n = 110) or conventional open surgery by thoracotomy (n = 107). Multiple regression analysis and propensity score matching was used to evaluate the influence of operation technique (thoracotomy versus VATS) on the length of post-operative hospitalization. RESULTS Operation time was longer in the thoracotomy-group (p = 0.0207). Conversion rate from VATS to open surgery by thoracotomy was 4.5%. Post-operative complication- (61 patients in thoracotomy- and 55 patients in VATS-group), recurrence- (3 patients in thoracotomy- and 5 in VATS-group) and mortality-rates (6.5% in thoracotomy- and 9.5% in VATS-group) did not differ between both groups; the length of (post-operative) stay at intensive care unit was longer in the VATS-group (p = 0.0023). Duration of chest tube drainage and prolonged air leak rate were similar among both groups, leading to a similar overall and post-operative length of hospital stay in both groups. Adjusted to clinically and statistically relevant confounders, multiple regression analysis showed an influence of the surgical technique on length of post-operative stay after pair matching of the patients (n = 84 in each group) by propensity score (B = - 0.179 for thoracotomy = 0 and VATS = 1, p = 0.032) leading to a reduction of 0.836 days after a VATS-approach compared to thoracotomy. CONCLUSIONS VATS in late stage (III) pleural empyema is feasible and safe. The decrease in post-operative hospitalization demonstrated by adjusted multiple regression analysis may indicate the minimally-invasive approach being safe, more tolerable for patients, and more effective.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Jörn Pons-Kühnemann
- Medical Statistics, Institute of Medical Informatics, Justus-Liebig-University of Giessen, Rudolf-Buchheim Strasse 6, 35392, Giessen, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany
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Sokouti M, Ghojazadeh M, Sokouti M, Sokouti B. Surgical and nonsurgical outcomes for treating a cohort of empyema thoracis patients: A monocenteric retrospective cohort study. Ann Med Surg (Lond) 2017; 24:19-24. [PMID: 29062481 PMCID: PMC5647471 DOI: 10.1016/j.amsu.2017.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background There are several studies reporting high success rates for surgical and nonsurgical treatments of empyema separately. The aim of current retrospective cohort study is to find the best treatment in low socio-economic areas. Material and methods A total of 149 patients were treated in the referring hospital from January 2002 to December 2008. The current retrospective cohort study was carried out by nonsurgical (medically & thoracenthesis & chest tube drainage with or without fibrinolytic agents) and surgical (VATS &open thoracotomy decortication methods) procedures in single center performed in thoracic and respiratory medicine wards. The independent t-test on demographic data was the statistical test tool. Results The complete cure and mortality rates for 130 patients were 27% (35 out of 130 patients) and 0.3% (1 out of 130 patients), respectively. Thirteen out of 149 patients that were estimated to be at stage II underwent VATS decortication. The results showed zero success rates for this procedure which was then converted to open thoracotomy decortication. And, 113 patients who underwent thoracotomy decortication had a cure rate of 96.4% (109 patients) and mortality rate of 1.8% (2 patients). Four (3.5%) patients needed thoracoplasty, 2 died and 2 (1.8%) needed open window thoracostomy resulted in empyema necessitans that remained uncured. Total hospitalization lengths for the patients treated by tube thoracostomy and thoracotomy decortication were (15.4 ± 2.1) and (6.2 ± 1.8) days (P < 0.001), respectively. The success rates between surgical and nonsurgical treatments were 98.2% and 27.1%. And, the difference between them was significant (P < 0.001). Conclusion Because of the advanced stages of empyema in our patients, thoracotomy decortication procedure is often the first rank choice with success rates higher than nonsurgical techniques. However, nowadays, the success rates of nonsurgical and VATS management of empyema thoracis are mostly reported in the literature. Outcomes of surgical and nonsurgical management for treating empyema thoracis patients were presented based on STROCSS criteria. Due to advanced stages of empyema in low socioendemic areas, thoracotomy decortication procedure proposed higher success rates. Success and cure rates, and hospitalization time showed significant differences between surgical and nonsurgical procedures.
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Affiliation(s)
- Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Srinivasnakshatri VK, Subramani P, Venkateshwaraprasad KN, Varma P. A fatal case of fungal empyema due to Candida krusei and Candida tropicalis: a rare occurrence with an atypical presentation. J Clin Diagn Res 2014; 8:DD01-2. [PMID: 25584222 PMCID: PMC4290240 DOI: 10.7860/jcdr/2014/10466.5205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/10/2014] [Indexed: 11/24/2022]
Abstract
Infections of the pleural cavity remain an important cause of morbidity and mortality despite advancement in diagnostic modalities and therapy. Community acquired empyema thoracis due to Candida species are rarely reported in paediatric literature. We hereby report an interesting case of empyema due to co-infection of Candida krusei with Candida tropicalis. A 11-year-old female child presented with respiratory distress. Chest X-ray showed massive pleural effusion, thoracocentesis showed it as purulent exudate and she was empirically treated with antibiotics. C. tropicalis and C. krusei were isolated from the pus sample proving to be fungal empyema. Inspite of antifungal agents and mechanical ventilation, her general condition rapidly deteriorated and she succumbed.
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Affiliation(s)
- Venkatesh Karkada Srinivasnakshatri
- Assistant Professor, Department of Paediatrics, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Tamaka, Kolar, Karanataka, India
| | - Parimala Subramani
- Assistant Professor, Department of Microbiology, SDUAHER, Tamaka, Kolar, Karanataka, India
| | | | - Puneet Varma
- Assistant Professor, Department of Microbiology, SDUAHER, Tamaka, Kolar, Karanataka, India
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Yu D, Buchvald F, Brandt B, Nielsen KG. Seventeen-year study shows rise in parapneumonic effusion and empyema with higher treatment failure after chest tube drainage. Acta Paediatr 2014; 103:93-9. [PMID: 24117621 DOI: 10.1111/apa.12426] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/20/2013] [Accepted: 09/19/2013] [Indexed: 12/19/2022]
Abstract
AIM To evaluate epidemiology, pre-admission characteristics and management of paediatric parapneumonic effusions (PPEs) and empyema in a tertiary paediatric pulmonary centre between 1993 and 2010. METHODS Retrospective chart review study using paediatric and thoracic database searches, with particular emphasis on pre-admission characteristics, disease stage (simple or complex effusion or empyema), general management and surgical procedures. RESULTS One hundred children were eligible, exhibiting a significant increase in incidence from 0.5 to 2.6 per 100 000 across the study period. Baseline characteristics were similar across disease stages. Streptococcus pneumoniae was the most common pathogen. Surgical intervention beyond chest tube drainage (CTD) was required in 50%; this rate showed a particular increase in children aged 0-5 years (OR, 3.1), but was otherwise not influenced by baseline characteristics, disease stage or use of intrapleural fibrinolytics. Length of hospitalisation did not differ across disease stages or primary interventional procedures. CONCLUSION This study confirmed an increasing incidence of PPEs and empyema in a Scandinavian tertiary paediatric pulmonary centre. Young children exhibited higher treatment failure after CTD. Length of hospitalisation was similar across disease stages and was comparable to previous reports according to primary interventional procedure.
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Affiliation(s)
- Danny Yu
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Frederik Buchvald
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Bodil Brandt
- Department of Thoracic Surgery; The Heart and Lung Surgical Clinic; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Kim G Nielsen
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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Khan YA. Bilateral suspected tuberculous empyema thoracis. APSP J Case Rep 2012; 3:13. [PMID: 22953307 PMCID: PMC3418046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 03/08/2012] [Indexed: 11/27/2022] Open
Abstract
Empyema thoracis is a well known complication following para-pneumonic effusions in paediatric age group. Usually it is unilateral but rarely could be bilateral. Herein we report a case of bilateral tuberculous empyema thoracis in a 12 years old, unvaccinated girl with a positive history of contact with tuberculosis. She was managed conservatively with tube thoracostomies and anti-tuberculous drugs. Emphasis is on the conservative approach and patience in management of patients with bilateral empyema thoracis.
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