Risk factors and prognostic predictors of recurrent bacterial empyema in patients after surgical treatment

Thoracic empyema is a severe infection with significant morbidity and mortality. Recurrence remains a challenge, impacting patient outcomes and healthcare costs. This study investigated the incidence and prognostic factors of empyema recurrence to enhance management strategies.

A retrospective cohort study was conducted on 1,000 patients over 18 years old with stage II or III thoracic empyema who underwent video-assisted thoracoscopic surgery (VATS) decortication between 2011 and 2022 at Changhua Christian Hospital in Taiwan. We excluded patients who had non-bacterial empyema. We also excluded those who experienced contralateral or same-admission recurrences. Clinical data were analyzed to identify factors associated with recurrence and outcomes.

Empyema recurred in 46 patients (4.6%), with a median recurrence time of 37.5 days. The recurrent group had higher rates of diabetes mellitus (47.8% vs. 31.7%, p = 0.022), stage III empyema (32.6% vs. 20.1%, p = 0.041), and pleural glucose levels ≤ 40 mg/dL (52.4% vs. 36.9%, p = 0.043). Streptococcus species infections were more prevalent among recurrent cases (p = 0.029). Delays from diagnosis to operation were longer in the recurrent group (10.46 ± 23.46 days). Recurrent patients experienced extended postoperative antibiotic use and longer intensive care unit stays and hospital admissions. Overall survival was significantly lower in the recurrent group during long-term follow-up (p < 0.001).

Empyema recurrence after VATS decortication worsens outcomes. Key risk factors include diabetes mellitus, low pleural glucose levels, Streptococcus infection, and delayed surgery. Early diagnosis, prompt surgical intervention, and careful management of comorbidities may be beneficial to reduce recurrence and improve patient outcomes.