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The New England Journal of Medicine Feb 2017
Topics: Adult; Dyspnea; Empyema, Tuberculous; Humans; Male; Mycobacterium tuberculosis; Thorax; Tomography, X-Ray Computed
PubMed: 28225672
DOI: 10.1056/NEJMicm1608914 -
Internal Medicine (Tokyo, Japan) Sep 2023A 91-year-old woman was brought to our hospital with altered consciousness. Blood tests showed an increased ammonia level of 468 μg/dL and a normal liver function....
A 91-year-old woman was brought to our hospital with altered consciousness. Blood tests showed an increased ammonia level of 468 μg/dL and a normal liver function. Chest computed tomography showed massive right pleural effusion with loculation. We immediately performed chest drainage using two drainage tubes. The pleural effusate pH was 8.5. We diagnosed her with right empyema leading to hyperammonemia and initiated ampicillin/sulbactam therapy. However, she developed progressive renal failure and died on the third day. Empyema caused by urease-producing bacteria can lead to hyperammonemia. This is the first report of hyperammonemia due to empyema in the English literature.
Topics: Female; Humans; Aged, 80 and over; Hyperammonemia; Empyema; Pleural Effusion; Tomography, X-Ray Computed; Drainage
PubMed: 36725045
DOI: 10.2169/internalmedicine.0922-22 -
Microorganisms Jan 2023Healthcare-seeking behavior changed during the COVID-19 pandemic and might alter the epidemiology of pleural empyema. In this study, the incidence, etiology and outcomes...
Healthcare-seeking behavior changed during the COVID-19 pandemic and might alter the epidemiology of pleural empyema. In this study, the incidence, etiology and outcomes of patients admitted for pleural empyema in Hong Kong in the pre-COVID-19 (January 2015-December 2019) and post-COVID-19 (January 2020-June 2022) periods were compared. Overall, was the predominant organism in <18-year-old patients, while anaerobes and polymicrobial infections were more frequent in adults. In the post-COVID-19 period, a marked decline in the incidence of pleural empyema in children was observed (pre-COVID-19, 18.4 ± 4.8 vs. post-COVID-19, 2.0 ± 2.9 cases per year, = 0.036), while the incidence in adults remained similar (pre-COVID-19, 189.0 ± 17.2 vs. post-COVID-19, 198.4 ± 5.0 cases per year; = 0.23). In the post-COVID-19 period, polymicrobial etiology increased (OR 11.37, < 0.0001), while etiology decreased (OR 0.073, < 0.001). In multivariate analysis, clinical outcomes (length of stay, ICU admission, use of intrapleural fibrinolytic therapy, surgical intervention, death) were not significantly different in pre- and post-COVID-19 periods. In conclusion, an increase in polymicrobial pleural empyema was observed during the pandemic. We postulate that this is related to the delayed presentation of pneumonia to hospitals.
PubMed: 36838268
DOI: 10.3390/microorganisms11020303 -
Cureus Jan 2021We report the case of a 36-year-old man with cirrhosis who presented with recurrent infection of his right-sided hepatic hydrothorax in the form of fever, dyspnea, and...
We report the case of a 36-year-old man with cirrhosis who presented with recurrent infection of his right-sided hepatic hydrothorax in the form of fever, dyspnea, and cough. The pleural fluid analysis showed transudative fluid with normal pH, lactic acid dehydrogenase, and glucose, but with growth. An uncommon diagnosis of high mortality, spontaneous bacterial empyema was made. Criteria for chest tube drainage were met, but he was managed without one. He developed hospital-acquired pneumonia during his stay, but his pleural fluid showed the same characteristics. His empyema and pneumonia were managed with antibiotics and other supportive measures. On follow-up, he was readmitted on three other occasions with similar complaints and succumbed to upper gastrointestinal bleed during the fifth admission. A chest tube is not indicated in patients with spontaneous bacterial empyema unless frank pus is present.
PubMed: 33633873
DOI: 10.7759/cureus.12829 -
The Annals of Thoracic Surgery Jun 2018Empyema affects up to 65,000 patients annually in the United States. Recent consensus guidelines demonstrate ambiguity about optimal treatment. We examined current...
BACKGROUND
Empyema affects up to 65,000 patients annually in the United States. Recent consensus guidelines demonstrate ambiguity about optimal treatment. We examined current treatment practices and outcomes for inpatient treatment of empyema using a comprehensive, longitudinal data set that encompasses an entire state cohort of hospitalized patients.
METHODS
We queried the Healthcare Cost and Utilization Project New York State Inpatient Database (2009 to 2014) for patients with primary empyema and subsequent readmissions. Patients were categorized into three groups by definitive treatment during their initial hospitalization: chest tube drainage, video-assisted thoracoscopic surgery (VATS) decortication and drainage, or open decortication and drainage. Treatment outcomes, including success rates, readmission, reintervention, and mortality, were compared between groups.
RESULTS
The cohort included 4,095 patients undergoing intervention for primary empyema discharged during this period with chest tube, VATS, or open drainage and decortication. Most patients received definitive operative management (chest tube: 38.2%, VATS: 32.1%, open: 29.8%; p < 0.001). Patients had a high mortality rate during their initial hospitalization (chest tube: 15.4%, VATS: 4.7%, open: 6.0%; p < 0.001) and a substantial 30-day readmission rate for empyema (chest tube: 7.3%, VATS: 3.8%, open: 4.1%; p < 0.001), with reintervention at readmission significantly higher for chest tube (6.1%) vs surgical patients (VATS: 1.9%, open 2.1%; p < 0.001).
CONCLUSIONS
This study characterizes recent treatment practices of patients with empyema. Higher readmission and reintervention rates were observed in patients managed with chest tubes, suggesting some of these patients may benefit from earlier definitive surgical intervention.
Topics: Aged; Chest Tubes; Drainage; Empyema, Pleural; Female; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 29550205
DOI: 10.1016/j.athoracsur.2018.02.027 -
Annals of the American Thoracic Society May 2018
Review
Topics: Empyema, Pleural; Fibrinolytic Agents; Humans; Pleural Effusion; Thrombolytic Therapy
PubMed: 29361235
DOI: 10.1513/AnnalsATS.201711-848PS -
World Journal of Hepatology Nov 2017This review considers the modern concepts of pathogenesis, diagnostic methods, and treatment principles of hepatic hydrothorax (HH). HH is the excessive (> 500 mL)... (Review)
Review
This review considers the modern concepts of pathogenesis, diagnostic methods, and treatment principles of hepatic hydrothorax (HH). HH is the excessive (> 500 mL) accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases. It causes respiratory failure which aggravates the clinical course of liver cirrhosis, and the emergence of spontaneous bacterial pleural empyema may be the cause of death. The information was collected from the PubMed database, the Google Scholar retrieval system, the Cochrane reviews, and the reference lists from relevant publications for 1994-2016 using the keywords: "liver cirrhosis", "portal hypertension", "hepatic hydrothorax", "pathogenesis", "diagnostics", and "treatment". To limit the scope of this review, only articles dealing with uncomplicated hydrothorax in patients with liver cirrhosis were included. The analysis of the data showed that despite the progress of modern hepatology, the presence of HH is associated with poor prognosis and high mortality. Most patients suffering from it are candidates for orthotopic liver transplantation. In routine clinical practice, stratification of the risk for an adverse outcome and the subsequent determination of individual therapeutic strategies may be the keys to the successful management of the patient's condition. The development of pathogenetic pharmacotherapy and optimization of minimally invasive treatment will improve the quality of life and increase the survival rate among patients with HH.
PubMed: 29152039
DOI: 10.4254/wjh.v9.i31.1197 -
Pneumologie (Stuttgart, Germany) Dec 2016
Topics: Aged; Diagnosis, Differential; Empyema, Pleural; Foreign-Body Reaction; Humans; Lung Neoplasms; Male; Pneumonia
PubMed: 27931074
DOI: 10.1055/s-0036-1596080 -
Journal of Clinical Medicine Mar 2022Empyema is known as a serious infection, and outcomes of empyema cases remain poor. Pleural fluid culture and blood culture have been reported to give unsatisfactory...
BACKGROUND
Empyema is known as a serious infection, and outcomes of empyema cases remain poor. Pleural fluid culture and blood culture have been reported to give unsatisfactory results. We introduce a novel pleural peels tissue culture during surgery and aim to improve the culture results of empyema.
METHODS
This was a retrospective study and was obtained from our institute. Patients with stage II or III empyema undergoing video-assisted thoracic surgery decortication from January 2019 to June 2021 were included in the study.
RESULTS
There were 239 patients that received a pleural peels tissue culture, a pleural fluid culture, and a blood culture concurrently during the perioperative period. Of these, 153 patients had at least one positive culture and 86 patients showed triple negative culture results. The positive culture rates were 46.9% for pleural peels tissue cultures, 46.0% for pleural fluid cultures, and 10% for blood cultures. The combination of pleural peels tissue culture and pleural fluid culture increased the positive rate to 62.7%. Streptococcus species and Staphylococcus species were the most common pathogens.
CONCLUSION
The combination of pleural peels tissue culture and pleural fluid culture is an effective method to improve the positive culture rate in empyema.
PubMed: 35407489
DOI: 10.3390/jcm11071882 -
BMC Infectious Diseases Jan 2023Fungal empyema is an uncommon disease and is associated with a high mortality rate. Surgical intervention is suggested in stage II and III empyema. However, there were...
BACKGROUND
Fungal empyema is an uncommon disease and is associated with a high mortality rate. Surgical intervention is suggested in stage II and III empyema. However, there were no studies that reported the outcomes of surgery for fungal empyema.
METHODS
This study is a retrospective analysis in a single institute. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. We separated the patients into a fungal empyema group and a bacterial empyema group according to culture results. We used 1:3 propensity score matching to reduce selection bias.
RESULTS
There were 1197 empyema patients who received surgery. Of these, 575 patients showed positive culture results and were enrolled. Twenty-eight patients were allocated to the fungal empyema group, and the other 547 patients were placed in the bacterial empyema group. Fungal empyema showed significantly longer intensive care unit stay (16 days vs. 3 days, p = 0.002), longer median ventilator usage duration (20.5 days vs. 3 days, p = 0.002), longer hospital stay duration (40 days vs. 17.5 days, p < 0.001) and a higher 30-day mortality rate (21.4% vs. 5.9%, p < 0.001). Fungal empyema revealed significantly poorer 1-year survival rate than bacterial empyema before matching (p < 0.001) but without significant difference after matching.
CONCLUSIONS
The fungal empyema patients had much worse surgical outcomes than the bacterial empyema patients. Advanced age and high Charlson Comorbidity Index score are independent predictors for poor prognosis. Prompt surgical intervention combined with the use of antifungal agents was the treatment choice for fungal empyema.
Topics: Humans; Retrospective Studies; Treatment Outcome; Thoracic Surgery, Video-Assisted; Empyema, Pleural; Bacteria
PubMed: 36609233
DOI: 10.1186/s12879-022-07978-z