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Updated: Jan 22, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
The microbiology of pleural infection in adults: a systematic review
Maged Hassan1,2,3, Tamsin Cargill4, Elinor Harriss5
1Oxford Pleural Unit, Oxford University Hospitals, Oxford, UK magedhmf@gmail.com.
Background And Objectives:
Pleural infection is a major cause of morbidity and mortality among adults. Identification of the offending organism is key to appropriate antimicrobial therapy. It is not known whether the microbiological pattern of pleural infection is variable temporally or geographically. This systematic review aimed to investigate available literature to understand the worldwide pattern of microbiology and the factors that might affect such pattern.
Data Sources And Eligibility Criteria:
Ovid MEDLINE and Embase were searched between 2000 and 2018 for publications that reported on the microbiology of pleural infection in adults. Both observational and interventional studies were included. Studies were excluded if the main focus of the report was paediatric population, tuberculous empyema or post-operative empyema.
Study Appraisal And Synthesis Methods:
Studies of ≥20 patients with clear reporting of microbial isolates were included. The numbers of isolates of each specific organism/group were collated from the included studies. Besides the overall presentation of data, subgroup analyses by geographical distribution, infection setting (community versus hospital) and time of the report were performed.
Results:
From 20 980 reports returned by the initial search, 75 articles reporting on 10 241 patients were included in the data synthesis. The most common organism reported worldwide was Staphylococcus aureus. Geographically, pneumococci and viridans streptococci were the most commonly reported isolates from tropical and temperate regions, respectively. The microbiological pattern was considerably different between community- and hospital-acquired infections, where more Gram-negative and drug-resistant isolates were reported in the hospital-acquired infections. The main limitations of this systematic review were the heterogeneity in the method of reporting of certain bacteria and the predominance of reports from Europe and South East Asia.
Conclusions:
In pleural infection, the geographical location and the setting of infection have considerable bearing on the expected causative organisms. This should be reflected in the choice of empirical antimicrobial treatment.
Insights
The worldwide microbiology of pleural infection varies by location and whether it is community- or hospital-acquired. Identifying causative organisms is crucial for effective antimicrobial therapy, guiding empirical treatment choices.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Pleural infection significantly contributes to adult morbidity and mortality.
- Accurate identification of causative organisms is essential for effective antimicrobial therapy.
- The global variability of pleural infection microbiology remains largely uncharacterized.
Purpose of the Study:
- To systematically review and synthesize global literature on the microbiology of adult pleural infections.
- To identify patterns in causative organisms and factors influencing these patterns, such as geography and infection setting.
- To inform empirical antimicrobial treatment strategies for pleural infections.
Main Methods:
- A systematic literature search of Ovid MEDLINE and Embase databases (2000-2018).
- Inclusion of observational and interventional studies reporting on adult pleural infection microbiology (≥20 patients).
- Exclusion of studies focused on pediatric, tuberculous, or post-operative empyema.
Main Results:
- Staphylococcus aureus was the most frequently reported organism globally.
- Geographic variations were observed, with pneumococci common in tropical regions and viridans streptococci in temperate regions.
- Hospital-acquired infections showed a higher prevalence of Gram-negative and drug-resistant organisms compared to community-acquired infections.
Conclusions:
- Geographical location and infection setting are critical determinants of the causative organisms in pleural infections.
- Empirical antimicrobial treatment choices should be tailored based on these epidemiological factors.
- Further research is needed to address reporting heterogeneity and geographical biases in existing literature.
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