Epidemiology of pleural empyema in English hospitals and the impact of influenza

Abstract

Pleural empyema represents a significant healthcare burden due to extended hospital admissions and potential requirement for surgical intervention. This study aimed to assess changes in incidence and management of pleural empyema in England over the last 10 years and the potential impact of influenza on rates.Hospital Episode Statistics (HES) data was used to identify patients admitted to English hospitals with pleural empyema between 2008 and 2018. Linear regression was used to analyse the relationship between empyema rates and influenza incidence recorded by Public Health England. The relationship between influenza and empyema was further explored using serological data from a prospective cohort study of patients presenting with pleural empyema.Between April 2008 and March 2018 there were 55 530 patients admitted with pleural empyema. There was male predominance (67% versus 33%) which increased with age. Cases have significantly increased from 4447 in 2008 to 7268 in 2017. Peaks of incidence correlated moderately with rates of laboratory-confirmed influenza in children and young adults (r=0·30). For 9 of the 10 years studied the highest annual point incidence of influenza coincided with the highest admission rate for empyema (with a 2-week lag). In a cohort study of patients presenting to a single UK hospital with pleural empyema/infection, 24% (17/72) had serological evidence of recent influenza infection compared to 7% in seasonally matched controls with simple parapneumonic or cardiogenic effusions (p<0·001).Rates of empyema admissions in England have steadily increased with a seasonal variation that is temporally related to influenza incidence. Patient-level serological data from a prospective study supports the hypothesis that influenza may play a pathogenic role in empyema development.

Bleeding Risk With Combination Intrapleural Fibrinolytic and Enzyme Therapy in Pleural Infection

“…Parameters related to higher IET-related bleeding have been identified that may lead to altered risk thresholds for treatment. Pleural infection is rising in incidence [1][2][3] and remains associated with prolonged hospital stays and high mortality. 4 Combination intrapleural fibrinolytic and enzyme therapy (IET) with tissue plasminogen activator (tPA) and deoxyribonuclease has been established as a surgery-sparing rescue treatment option.…”

Parapneumonic effusions related toStreptococcus pneumoniae: serotype and disease severity trends from 2006 to 2018 in Bristol, UK

“…Recent national epidemiological studies of pleural infection from North America also show significant increases in pleural infection rates both in children [22] and adults [23]. Likewise, a Danish study from 1997-2001, showed steadily rising pleural infection rates in the elderly [24] and a UK study showed annual rises in adult pleural infections from 2008-17 [25], most marked in over 60-year-old individuals with a 194% increase over the decade. Both overall admissions and microbiological testing at the study hospitals increased progressively during our study period, but not as much as disease incidence, suggesting this did not solely account for the increasing incidence observed.…”

“…Overall, pre-existing medical conditions were commonly present amongst adults with pneumococcal parapneumonic effusions, although the median patient age was lower than that seen in other cohorts of parapneumonic effusions [12, 25]. Uniquely, this cohort of parapneumonic effusion cases were all attributable to pneumococcal infection, which may cause the condition in younger patients than other pathogens [25, 38]. Despite this, the burden of pre-existing medical comorbidity was equivalent: both SPE and pleural infection patients had significant cardiac (44%) and respiratory (43%) conditions predominating.…”

The impact of the COVID-19 pandemic on pleural infection incidence: a UK multicentre retrospective analysis

“…A huge rise in pleural infection cases is well documented following the influenza pandemic in 1918 [5] and a recent epidemiological study from Arnold et al also found that for 9 of the 10 years studied, the highest annual point incidence of influenza nationally coincided with the highest admission rate for pleural infection [6].…”