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Intensive Care Medicine

Published in:

01-04-2006 | Original

The changing pathogens of complicated parapneumonic effusions or empyemas in a medical intensive care unit

Authors: Chih-Yen Tu, Wu-Huei Hsu, Te-Chun Hsia, Hung-Jen Chen, Kuo-Liang Chiu, Liang-Wen Hang, Chuen-Ming Shih

Published in: Intensive Care Medicine | Issue 4/2006

Abstract

Objectives

To assess the incidence, pathogens, and outcome of complicated parapneumonic effusions or empyemas in a medical intensive care unit (MICU) patients with pleural effusions.

Design and setting

Prospective study of febrile MICU patients with pleural effusion carried out in a tertiary care hospital between April 2001 and September 2003.

Patients

The study included 175 patients with a temperature above 38° for more than 8 h with evidence of pleural effusion confirmed by chest radiography and ultrasound.

Intervention

Routine thoracentesis and effusion cultures.

Results

The prevalence of complicated parapneumonic effusions or thoracic empyemas in febrile MICU patients with pleural effusions was 45% (78/175). A total of 78 micro-organisms were isolated from the pleural fluid of 58 patients (positive microbiological culture 74%) including aerobic Gram-negative (n = 45), aerobic Gram-positive (n = 23), anaerobic (n = 5), Myobacterium tuberculosis (n = 3), and Candida (n = 2). The infection-related mortality rate of complicated parapneumonic effusions or empyemic patients in the MICU was 41% (32/78).

Conclusion

The development of complicated parapneumonic effusions or thoracic empyemas in MICU patients is a high-mortality disease. The increasing incidence of aerobic Gram-negative pathogens in empyema has become a more urgent problem.

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Fartoukh M, Azoulay E, Galliot R, Le Gall JR, Baud F, Chevret S, Schlemmer B (2002) Clinically documented pleural effusions in medical ICU patients: how useful is routine thoracentesis? Chest 121:178–184PubMedCrossRef

Tu CY, Hsu WH, Hsia TC, Hsia TC, Chen HJ, Tsai KD, Hung CW, Shih CM (2004) Pleural effusions in febrile medical ICU patients: chest ultrasound study. Chest 126:1274–1280CrossRefPubMed

Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA (1997) Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest 111:1018–1025PubMedCrossRef

Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA 274:639–644CrossRefPubMed

Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440PubMed

Campbell GD, Niederman MS, Broughton WA, Gleeson K, Hornick DB, Lynch JP, Craven DE, Fein AM, Fink MP, Mandell LA, Mason CM, Torres A, Wunderink RG (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies. A consensus statement. Am J Respir Crit Care Med 153:1711–1725PubMed

Erbay H, Yalcin AN, Serin S, Turgut H, Tomatir E, Cetin B, Zencir M (2003) Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 29:1482–1488CrossRefPubMed

Leroy O, Meybeck A, d'Escrivan T, Devos P, Kipnis E, Georges H (2003) Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia. Intensive Care Med 29:2170–2173CrossRefPubMed

Brook I, Frazier EH (1993) Aerobic and anaerobic microbiology of empyema: a retrospective review in two military hospitals. Chest 103:1502–1507PubMedCrossRef

10.

Varkey B, Rose HD, Kutty CP, Politis J (1981) Empyema thoracis during a ten-year period: analysis of 72 cases and comparison to a previous study (1952–1967). Arch Intern Med 141:1771–1776CrossRefPubMed

11.

Smith JA, Mullerworth MH, Westlake GW, Tatoulis J (1991) Empyema thoracis: a 14-year experience in a teaching center. Ann Thorac Surg 51:39–42PubMedCrossRef

12.

Vianna NJ (1971) Nontuberculous bacterial empyema in patients with and without underlying disease. JAMA 215:69–75CrossRefPubMed

13.

Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118:146–155CrossRefPubMed

14.

Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD (1998) The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 244:379–386CrossRefPubMed

15.

Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: A risk factor for hospital mortality among critically ill patients. Chest 115:462–474CrossRefPubMed

16.

Feldman C, Ross S, Mahomed AG, Omar J, Smith C (1995) The aetiology of severe community-acquired pneumonia and its impact on initial, empiric, antimicrobial chemotherapy. Respir Med 86:187–192CrossRef

17.

Moine P, Vercken JB, Chevret S, Chastang C, Gajdos P (1994) Severe community-acquired pneumonia etiology, epidemiology, and prognostic factors. Chest 105:1487–1495PubMedCrossRef

18.

Rello J, Quintana E, Ausina V, Net A, Prats G (1993) A three-year study of severe community-acquired pneumonia with emphasis on outcome. Chest 103:232–235PubMedCrossRef

19.

Valles J, Mesalles E, Mariscal D, del Mar Fernandez M, Pena R, Jimenez JL, Rello J (2003) A 7-year study of severe hospital-acquired pneumonia requiring ICU admission. Intensive Care Med 29:1981–1988CrossRefPubMed

20.

Pareja A, Bernal C, Leyva A, Piedrola G, Maroto MC (1992) Etiologic study of patients with community-acquired pneumonia. Chest 101:1207–1210PubMedCrossRef

21.

Rello J, Bodi M, Mariscal D, Navarro M, Diaz E, Gallego M, Valleset J (2003) Microbiological testing and outcome of patients with severe community-acquired pneumonia. Chest 123:174–180CrossRefPubMed

22.

Emori TG, Gaynes RP (1993) An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 6:428–442PubMed

Title: The changing pathogens of complicated parapneumonic effusions or empyemas in a medical intensive care unit
Authors: Chih-Yen Tu
Wu-Huei Hsu
Te-Chun Hsia
Hung-Jen Chen
Kuo-Liang Chiu
Liang-Wen Hang
Chuen-Ming Shih
Publication date: 01-04-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-005-0064-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The changing pathogens of complicated parapneumonic effusions or empyemas in a medical intensive care unit

Abstract

Objectives

Design and setting

Patients

Intervention

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Design and setting

Patients

Intervention

Results

Conclusion

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