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An urgent problem of aerobic gram-negative pathogen infection in complicated parapneumonic effusions or empyemas

Yu-Chao Lin1, Chih-Yen Tu, Wei Chen

  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

Internal Medicine (Tokyo, Japan)
|August 7, 2007
PubMed
Abstract

Insights

Complicated parapneumonic effusion and empyema are serious conditions. This study found aerobic Gram-negative bacteria are increasingly common, especially in older patients, leading to higher mortality and longer hospital stays.

Area of Science:

  • Infectious Diseases
  • Pulmonary Medicine
  • Microbiology

Background:

  • Complicated parapneumonic effusion and empyema are severe diseases with high mortality rates.
  • Changes in common causative microorganisms are suspected due to evolving medical practices and patient demographics.
  • Current epidemiological data on bacteriology is crucial for guiding empirical antibiotic selection.

Purpose of the Study:

  • To investigate the changing bacteriology of complicated parapneumonic effusion and empyema.
  • To identify the common bacterial pathogens and assess patient outcomes.
  • To inform empirical antibiotic treatment strategies.

Main Methods:

  • A retrospective chart review was conducted at a tertiary medical center.
  • Data from 304 patients diagnosed with complicated parapneumonic effusions or empyemas between December 2000 and June 2004 were analyzed.
  • Microbiological cultures of pleural fluid were examined to identify bacterial pathogens.

Main Results:

  • The overall mortality rate for these conditions was 23%.
  • A microbiological culture yield of 68% identified various bacteria, including aerobic Gram-negative (n=129), aerobic Gram-positive (n=105), and anaerobic bacteria (n=51).
  • Aerobic Gram-negative bacteria were more prevalent in older patients and associated with significantly higher mortality and longer hospital stays (p<0.001).

Conclusions:

  • The rising incidence of aerobic Gram-negative bacterial infections is a significant concern.
  • These infections appear to lead to more severe clinical presentations in patients with complicated parapneumonic effusions or empyemas.
  • This trend necessitates updated strategies for empirical antibiotic therapy.

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