Bacteriological aetiology and antimicrobial treatment of pleural empyema

Abstract

The early diagnosis of pleural infection could be optimized. In this North-European patient population, we suggest that the recommended empiric antimicrobial treatment be changed to cefuroxime plus metronidazole for community-acquired and nosocomial infections.

Resistance to Co-Amoxiclav (Augmentin) in Community-Acquired and Nosocomial Pleural Infections

“…Accordingly, although ICU patients aforementioned had small bore pleural pigtail catheter, their need for chest tube drainage, intra-pleural fibrinolysis and thoracic surgery was particularly low (9%, 4% and 4% respectively), rendering the characteristics of the pleural infection and its management different from ours. On the other hand, a study found a significant association between adequate empirical therapy and a decrease in hospital mortality (OR 0.43; p=0.02) in the multivariate analysis, consistent with the results of our study [5].…”

“…Subjects were admitted in our ICU if chest tube drainage was needed. Though, our subjects did not represent a real ICU population with subsequent elevated mortality, but is in agreement with previous reports accounting for by mortality rates of about 4.7% to 27%, in patients with complicated pleural effusions [5,15,17]. Maskell found a 12-month mortality rate of about 22%, with a significant increase in patients with nosocomial infections (45%; OR 4.24), the mortality rates increased when S. aureus, GNB, or mixed aerobic bacteria where found, compared to anaerobes, Streptococcal, or culture-negative infections [6].…”

“…The differences between nosocomial and community-acquired thoracic empyema included a predominance of infection with S. aureus and group 2 enterobacteria in the nosocomial empyema, also found by others [5,15]. We cannot recommend more judicious antimicrobial therapy in the light of our ecology.…”

“…However, a probabilistic antibiotic with co-amoxiclav is questionable, even in community-acquired empyema. Accordingly, adequate coverage based on in vitro susceptibility of micro-organisms found in communityacquired and nosocomial pleural infections, was reported to be only 52% (49% to 53%) and 84% (78% to 86%) with the association of metronidazole and either penicillin (Scandinavian recommended antimicrobial therapy) or cefuroxime, respectively [5].…”

“…The flora found in the condition of community-acquired was gladly polymorphic and often included Gram-positive cocci and anaerobes. This feature was acknowledged in more recent studies [5,6]. In empyema thoracis, systemic antibiotic therapy is recommended.…”