Community-acquired thoracic empyema in young adults

To evaluate the clinical characteristics, bacteriology, and therapeutic outcomes of community-acquired thoracic empyema (CATE) in young adults.

From December 2000 to December 2005, 428 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were retrospectively reviewed. In total, there were 64 young adult patients who were diagnosed with CATE enrolled in our series, including 56 men (87.5%) and 8 women (12.5%). Ages ranged from 18 to 44 years old (mean = 37).

The most common underlying disease was alcoholism (28%), and the most common isolated microorganism was Viridans streptococci (27.3%). Among the 62 patients who underwent an invasive drainage procedure, 40 (64%) patients who received pigtail tube drainage as their initial treatment yielded a success rate of 70%. Fifteen (24%) patients who received video-assisted thoracoscopic surgery as first-line treatment yielded a success rate of 100%. To evaluate the risk factors for developing septic shock, we found that serum C-reactive protein (CRP) level on the first admission day (22.9 +/- 9.1 versus 13.2 +/- 8.1 mg/dL), presence of bacteremia (60 versus 13%), occurrence of polymicrobial infection (30 versus 5%) and inadequate antibiotic use (30 versus 7%) had statistical significance (P < 0.05).

Viridans streptococci was the most frequently isolated causative microorganism in young adults with CATE and alcoholism was the most common underlying disease. Moreover, a higher serum CRP level on the first day of admission, occurrence of bacteremia, presence of polymicrobial infection and inadequate antibiotic use were significant risk factors for developing septic shock.