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Pediatric Radiology Nov 2022While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these...
BACKGROUND
While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these children.
OBJECTIVE
Standardizing fibrinolytic administration among interventional radiology (IR) physicians to improve patient outcomes in pediatric parapneumonic effusion.
MATERIALS AND METHODS
We introduced a hospital-wide clinical pathway for parapneumonic effusion (1-2 mg tissue plasminogen activator [tPA] twice daily based on pleural US grade); we then collected prospective data for IR treatment May 2017 through February 2020. These data included demographics, co-morbidities, pediatric intensive care unit (PICU) admission, pleural US grade, culture results, daily tPA dose average, twice-daily dose days, skipped dose days, pleural therapy days, need for chest CT/a second IR procedure/surgical drainage, and length of stay. We compared the prospective data to historical controls with IR treatment from January 2013 to April 2017.
RESULTS
Sixty-three children and young adults were treated after clinical pathway implementation. IR referrals increased (P = 0.02) and included higher co-morbidities (P = 0.005) and more PICU patients (P = 0.05). Mean doses per day increased from 1.5 to 1.9 (P < 0.001), twice-daily dose days increased from 38% to 79% (P < 0.001) and median pleural therapy days decreased from 3.5 days to 2.5 days (P = 0.001). No IR patients needed surgical intervention. No statistical differences were observed for gender/age/weight, US grade, need for a second IR procedure or length of stay. US grade correlated with greater positive cultures, need for chest CT/second IR procedure, and pleural therapy days.
CONCLUSION
Interventional radiology physician standardization improved on a clinical pathway for fibrinolysis of parapneumonic effusion. Despite higher patient complexity, pleural therapy duration decreased. There were no chest tube failures needing surgical drainage.
Topics: Young Adult; Humans; Child; Tissue Plasminogen Activator; Empyema, Pleural; Prospective Studies; Pleural Effusion; Thrombolytic Therapy; Fibrinolytic Agents; Retrospective Studies
PubMed: 35451632
DOI: 10.1007/s00247-022-05365-z -
The Korean Journal of Internal Medicine Jul 2019
Topics: Bronchoalveolar Lavage Fluid; Empyema, Pleural; Escherichia coli; Home Care Services; Humans; Male; Middle Aged; Quadriplegia; Respiration, Artificial; Streptococcus intermedius; Therapeutic Irrigation; Thoracotomy; Treatment Outcome
PubMed: 30836744
DOI: 10.3904/kjim.2017.359 -
Respirology (Carlton, Vic.) Jan 2018
Topics: Empyema, Pleural; Humans; Pleural Diseases; Pleural Effusion
PubMed: 28926164
DOI: 10.1111/resp.13171 -
The Annals of Thoracic Surgery Oct 2009
Review
Topics: Empyema, Pleural; Humans; Negative-Pressure Wound Therapy; Thoracostomy; Treatment Outcome
PubMed: 19766796
DOI: 10.1016/j.athoracsur.2009.06.071 -
Therapeutic Advances in Respiratory... 2020The predominance of neutrophils in pleural effusions of patients with different serious impairments of the pleural cavity organs is often found. The aim of this study...
BACKGROUND
The predominance of neutrophils in pleural effusions of patients with different serious impairments of the pleural cavity organs is often found. The aim of this study was to identify the type of injury using the cytological-energy analysis of pleural effusions.
METHODS
We analysed 635 samples of pleural effusions with predominance of neutrophils. We compared the values of the coefficient of energy balance (KEB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) catalytic activities in the following subgroups of patients: with transudative effusions, purulent pneumonia, chest empyema and after chest surgery with and without purulent complications. Statistical analysis was performed using the ANOVA Kruskal-Wallis test ( < 0.05 was considered as significant).
RESULTS
We found the lowest KEB values in pleural effusions of patients with chest empyema and their gradual increases in patients with purulent pneumonia and with transudative effusions. We observed the highest LDH and AST enzymes activity in patients with chest empyema and their gradual decrease in patients with purulent pneumonia and with transudative effusions. LDH and AST enzymes activity was significantly higher in pleural effusions of patients after chest surgery with purulent complications compared with non-purulent cases.
CONCLUSION
The most intensive inflammation and the most extensive tissue destruction in the pleural cavity were found in patients with chest empyema. Significantly better parameters were observed in patients with purulent pneumonia. The absence of serious inflammation and the absence of tissue destruction were typical for patients with transudative effusions. Finally, our results confirmed an anticipated higher tissue destruction in patients after chest surgery. Significantly worse injury was found in surgical patients with purulent complications compared with non-purulent ones.
Topics: Aspartate Aminotransferases; Biomarkers; Empyema, Pleural; Energy Metabolism; Humans; L-Lactate Dehydrogenase; Neutrophils; Pleural Effusion; Pneumonia; Postoperative Complications; Retrospective Studies; Thoracic Surgical Procedures
PubMed: 32600177
DOI: 10.1177/1753466620935772 -
BMJ Case Reports Oct 2019We present a very rare case of concurrent empyema and liver abscess caused by Fusobacterium. Our patient presented with 3-month history of subtle abdominal discomfort... (Review)
Review
We present a very rare case of concurrent empyema and liver abscess caused by Fusobacterium. Our patient presented with 3-month history of subtle abdominal discomfort and cough leading to eventually presenting with marked chest pain, dyspnoea and septic shock. CT revealed a liver abscess and large right-sided pleural effusion. Drainage of the pleural effusion yielded gross pus with the growth of , while drainage of the liver abscess yielded The patient responded to drainage and antibiotic therapy with resolution of symptoms and decrease in the size of empyema and abscess on follow-up imaging. We also include a review if literature of related fusobacterial infections.
Topics: Empyema, Pleural; Fusobacterium; Fusobacterium Infections; Humans; Liver Abscess, Pyogenic; Male; Middle Aged
PubMed: 31615779
DOI: 10.1136/bcr-2019-231994 -
The Annals of Thoracic Surgery Jul 2010
Topics: Empyema, Pleural; Humans; Negative-Pressure Wound Therapy; Thoracotomy
PubMed: 20609791
DOI: 10.1016/j.athoracsur.2010.05.026 -
The Journal of Thoracic and... Dec 2018
Topics: Empyema, Pleural; Humans; Pneumonectomy; Prognosis; Respiratory Distress Syndrome; Respiratory Insufficiency
PubMed: 30449586
DOI: 10.1016/j.jtcvs.2018.09.019 -
Frontiers in Cellular and Infection... 2021Identification of the offending organism and appropriate antimicrobial therapy are crucial for treating empyema. Diagnosis of empyema is largely obscured by the...
Identification of the offending organism and appropriate antimicrobial therapy are crucial for treating empyema. Diagnosis of empyema is largely obscured by the conventional bacterial cultivation and PCR process that has relatively low sensitivity, leading to limited understanding of the etiopathogenesis, microbiology, and role of antibiotics in the pleural cavity. To expand our understanding of its pathophysiology, we have carried out a metagenomic snapshot of the pleural effusion from 45 empyema patients by Illumina sequencing platform to assess its taxonomic, and antibiotic resistome structure. Our results showed that the variation of microbiota in the pleural effusion is generally stratified, not continuous. There are two distinct microbiome clusters observed in the forty-five samples: HA-SA type and LA-SA type. The categorization is mostly driven by species composition: HA-SA type is marked by as the core species, with other enriched 6 bacteria and 3 fungi, forming a low diversity and highly stable microbial community; whereas the LA-SA type has a more diverse microbial community with a distinct set of bacterial species that are assumed to be the oral origin. The microbial community does not shape the dominant antibiotic resistance classes which were common in the two types, while the increase of microbial diversity was correlated with the increase in antibiotic resistance genes. The existence of well-balanced microbial symbiotic states might respond differently to pathogen colonization and drug intake. This study provides a deeper understanding of the pathobiology of pleural empyema and suggests that potential resistance genes may hinder the antimicrobial therapy of empyema.
Topics: Anti-Bacterial Agents; Bacteria; Drug Resistance, Microbial; Empyema, Pleural; Humans; Metagenomics; Microbiota
PubMed: 33796482
DOI: 10.3389/fcimb.2021.637018 -
The Annals of Thoracic Surgery Jan 2021Previous studies of decortication for empyema demonstrated that patient characteristics are associated with mortality, but the relationship of infectious pathogen to...
BACKGROUND
Previous studies of decortication for empyema demonstrated that patient characteristics are associated with mortality, but the relationship of infectious pathogen to outcome has not been described. Our objective was to analyze the association of microbiology and antibiotic resistance with postoperative mortality after decortication for empyema. We hypothesized that bacterial pathogens, antibiotic resistance, and patient characteristics would all contribute to perioperative morbidity and mortality.
METHODS
Patients undergoing pulmonary decortication for empyema from January 1, 2010 to October 1, 2017 were reviewed retrospectively. Cases were matched with microbiology cultures. Outcomes of interest were a composite of death, tracheostomy, initial ventilator support greater than 48 hours, or unexpected intensive care unit readmission. Antibiotic resistance was categorized as present or absent, and the number of antibiotics with resistance was counted for each patient. We describe the relationship of patient characteristics, antibiotic resistance, and microbiology to mortality.
RESULTS
During the study period, 185 patients underwent decortication, 118 of whom had a diagnosis of primary empyema (63.8%). Positive culture results were present in 79 of 185 patients (43%). The most common isolate was Streptococcus, which was present in 29 of 79 (37%), followed by Staphylococcus in 19 of 79 (24%). Of 79 patients, 11 had fungal infections (13.9%). In addition, 16 of 79 patients had polymicrobial empyema (20%). Of 185 patients, 30 experienced the composite adverse outcome (16.2%). In multivariable regression, the composite adverse outcome was associated with emphysema, Candida in pleural culture, and antibiotic resistance count.
CONCLUSIONS
Perioperative mortality and morbidity after decortication for empyema is considerable. In this cohort, infections with increasing antibiotic resistance are associated with morbidity and mortality among patients with empyema.
Topics: Adult; Aged; Drug Resistance, Microbial; Empyema, Pleural; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies
PubMed: 32857996
DOI: 10.1016/j.athoracsur.2020.06.056