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Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort
Cheol-Kyu Park1, Hyoung-Joo Oh1, Ha-Young Choi1
1Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
Background:
Identification and understanding of the pathogens responsible for pleural infection is critical for appropriate antibiotic treatment. This study sought to determine the microbiological characteristics of pleural infection and to identify potential predictive factors associated with mortality.
Methods:
In this retrospective study, we analyzed patient data from 421 cases of parapneumonic effusion. A total of 184 microorganisms were isolated from 164 patients, using two culture systems: a standard method and a method using pairs of aerobic and anaerobic blood culture bottles.
Results:
The most frequently isolated microorganisms were streptococci (31.5%), followed by staphylococci (23.4%), gram-negative bacteria (18.5%) and anaerobes (10.3%). Streptococci were the main microorganisms found in standard culture (41.9%) and community-acquired infections (52.2%), and were susceptible to all antimicrobial agents in drug sensitivity testing. Staphylococci were the most frequently isolated pathogens in blood cultures (30.8%) and hospital-acquired infections (38.3%), and were primarily multidrug-resistant (61.8%). In multivariate analysis, the following were significant predictive factors for 30-day mortality among the total population: CURB-65 ≥ 2 (aOR 5.549, 95% CI 2.296-13.407, p<0.001), structural lung disease (aOR 2.708, 95% CI 1.346-5.379, p = 0.004), PSI risk class IV-V (aOR 4.714, 95% CI 1.530-14.524, p = 0.007), no use of intrapleural fibrinolytics (aOR 3.062, 95% CI 1.102-8.511, p = 0.014), hospital-acquired infection (aOR 2.205, 95% CI 1.165-4.172, p = 0.015), age (aOR 0.964, 95% CI 0.935-0.994, p = 0.018), and SOFA score ≥2 (aOR 2.361, 95% CI 1.134-4.916, p = 0.022).
Conclusion:
In this study, common pathogens causing pleural infection were comparable to previous studies, and consisted of streptococci, staphylococci, and anaerobes. CURB-65 ≥2, structural lung disease, PSI risk class IV-V, no use of intrapleural fibrinolytics, hospital-acquired infection, older age, and SOFA score ≥ 2 are potential predictors of mortality in pleural infection.
Insights
This study identified common pathogens in pleural infections, including streptococci and staphylococci. Several factors like CURB-65 score and lung disease predict mortality in pleural infection patients.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Understanding pathogens in pleural infection is crucial for effective antibiotic therapy.
- This study aimed to characterize pleural infection microbiology and identify mortality predictors.
Purpose of the Study:
- To determine the microbiological profile of pleural infections.
- To identify factors predicting mortality in patients with pleural infection.
Main Methods:
- Retrospective analysis of 421 parapneumonic effusion cases.
- Isolation of 184 microorganisms using standard and blood culture bottle methods.
Main Results:
- Streptococci were common in standard cultures and community-acquired infections, while staphylococci predominated in blood cultures and hospital-acquired infections.
- Multidrug-resistant staphylococci were frequently observed.
- Predictors of 30-day mortality included CURB-65 score ≥ 2, structural lung disease, PSI risk class IV-V, no intrapleural fibrinolytics, hospital-acquired infection, older age, and SOFA score ≥ 2.
Conclusions:
- Microbiological findings for pleural infections align with previous research, with streptococci, staphylococci, and anaerobes being prevalent.
- Identified risk factors like CURB-65 score, lung disease, and infection severity can predict mortality in pleural infection.
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