The Spectrum of Pneumococcal Empyema in Adults in the Early 21st Century

Burgos, Joaquín; Luján, Manel; Falcó, Vicenç; Sánchez, Ana M.; Puig, Mireia; Borrego, Astrid; Fontanals, Dionísia; Planes, Ana María; Pahissa, Albert; Rello, Jordi

doi:10.1093/cid/cir354

Cited by 66 publications

(59 citation statements)

References 37 publications

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“…Subsequent treatment shall refer to the bacteria source and culture results (blood, phlegm and pleural effusion), as well as antibiotics activity in the pleural effusion for adjustment of antibiotics (35). The thoracic cavity and lungs are significantly different in terms of oxygen content, pH and others; thus, the bacterial spectrum of the thoracic cavity infection would be not be completely same as that of the pneumonia (4,36). The most common pathogen of community-acquired pleural infection is streptococcus (37,38), followed by anaerobion and staphylococcus (such subject is pathogen, so the added coverage is unsuitable, I think).…”

Section: Antibiotic Treatmentmentioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication.According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future.

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Section: Antibiotic Treatmentmentioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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“…Pleural infection hospitalises over 65,000 people in the UK and USA each year and its incidence continues to increase worldwide (1)(2)(3)(4). Treatment involves evacuation of infected pleural fluid via chest tube drainage and antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. The Alteplase Dose Assessment for Pleural Infection Therapy Project

et al. 2017

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“…Specific serotypes have also been related with particular clinical presentations of pneumococcal disease. Thus, after the implementation of the 7-valent conjugate vaccine, an increase of suppurative complications were observed, associated with the emergence of serotypes 1 and 3 [15,16]. In the same way, recent reports have found that septic shock in patients with pneumococcal pneumonia developed more frequently in infections caused by serotypes 3 and 19A [10,11].…”

Section: Discussionmentioning

confidence: 84%

“…Although not statistically significant, serotype 1 showed a trend to be a protective factor of the development of respiratory failure. The paradox of this serotype with a high capacity to develop invasive illness and empyema in young adults but with a lesser tendency to cause severe illness [6,15,16] could explain why the rates of empyema were similar in both groups.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes

et al. 2013

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Pneumococcal serotypes are one of the main determinants of pneumococcal disease severity; however, data about their implication in respiratory failure are scarce.We conducted an observational study of adults hospitalised with invasive pneumococcal pneumonia to describe the host-and pathogen-related factors associated with respiratory failure.Of 1258 adults with invasive pneumococcal disease, 615 (48.9%) had respiratory failure at presentation. Patients with respiratory failure were older (62.1 years versus 55.4 years, p,0.001) and had a greater proportion of comorbid conditions. They also had a greater proportion of septic shock (41.7% versus 6.1%, p,0.001), required admission to the intensive care unit more often (38.4% versus 4.2%, p,0.001) and had a higher mortality (25.5% versus 3.5%, p,0.001). After adjustment, independent risk factors for respiratory failure were: age .50 years (OR 1.63, 95% CI 1.15-2.3), chronic lung disease (OR 1.54, 95% CI 1.1-2.15), chronic heart disease (OR 1.49, 95% CI 1.01-2.22) and infection caused by serotypes 3 (OR 1.97, 95% CI 1.23-3.16), 19A (OR 2.34, 95% CI 1.14-4.42) and 19F (OR 3.55,).In conclusion, respiratory failure is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Pneumococcal serotypes 3, 19A and 19F are the main risk factors for this complication. @ERSpublications Respiratory failure in invasive pneumonia is determined by older age, comorbidities and serotypes 3, 19A and 19F

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The Spectrum of Pneumococcal Empyema in Adults in the Early 21st Century

Abstract: The incidence of pneumococcal empyema in young adults has increased during the postvaccine period, mainly as a result of the emergence of serotype 1. Serotypes 1 and 3 are the main determinants of development of this suppurative complication.

Cited by 66 publications

References 37 publications

Infectious pleural effusion status and treatment progress

Infectious pleural effusion status and treatment progress

Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. The Alteplase Dose Assessment for Pleural Infection Therapy Project

Risk factors for respiratory failure in pneumococcal pneumonia: the importance of pneumococcal serotypes

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