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Complicated parapneumonic effusion and empyema thoracis: microbiologic and therapeutic aspects

Duygu Ozol1, Sibel Oktem, Erturk Erdinc

  • 1Department of Chest Disease, Fatih University Hospital, Ciftlik cad. no. 57 Besevler, 06510 Ankara, Turkey. dozol@hotmail.com

Respiratory Medicine
|July 7, 2005
PubMed

Insights

This study found that intrapleural streptokinase (IPS) did not improve clinical outcomes for pleural infections. While safe, IPS did not reduce hospitalization duration, mortality, or surgical needs compared to chest tube drainage alone.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Thoracic Surgery

Background:

  • Pleural infections, including complicated parapneumonic effusion and empyema, are associated with significant morbidity, mortality, and prolonged hospital stays.
  • Optimal treatment strategies for pleural infections remain a subject of debate.
  • The efficacy of streptokinase as an adjunctive therapy to chest tube drainage for improving clinical outcomes is controversial.

Purpose of the Study:

  • To investigate the etiological and microbiological factors contributing to pleural infections.
  • To evaluate the impact of intrapleural streptokinase (IPS) adjunctive to chest tube drainage on clinical outcomes such as hospitalization duration, need for surgery, and mortality.

Main Methods:

  • Retrospective chart review of 107 patients diagnosed with complicated parapneumonic effusion or empyema.
  • Patients were categorized into three groups: thoracentesis (Group 1), chest tube drainage (Group 2), and chest tube drainage with intrapleural streptokinase (Group 3).
  • Analysis of etiological, microbiological, and clinical outcome data, including hospitalization time, success rates, and mortality.

Main Results:

  • Staphylococcus aureus was the most common bacteriological agent identified.
  • Mean hospitalization time was significantly shorter in the thoracentesis group compared to the other two groups (P<0.05).
  • No significant differences were observed in hospitalization duration, mortality rate (8.4%), or success rates between chest tube drainage alone and chest tube drainage with IPS (P>0.05).

Conclusions:

  • Intrapleural streptokinase is a safe adjunctive procedure for managing pleural infections.
  • However, IPS did not demonstrate a significant effect on reducing hospitalization duration, mortality, or improving success rates compared to chest tube drainage alone.
  • Mortality remains particularly high in patients with co-existing medical conditions.

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