A RETROSPECTIVE CASE REVIEW ANALYSIS OF THE MICROBIOLOGY AND NONSURGICAL AND SURGICAL INTERVENTIONS OF EMPYEMA IN ADULTS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Appropriate treatment of empyema outside of drainage (of some kind) is uncertain. Treatment options have varied from percutaneous aspiration and closed chest tube drainage, sometimes with instillation of intrapleural fibrinolytics (“lytics”) to finally surgical interventions such as video-assisted thoracoscopic procedures and thoracotomy drainage. With the incidence rate rising every year, optimizing treatment should lead to fewer hospital days, complications, and possible improved morbidity and or mortality. METHODS: This is a retrospective cohort study of adult patients admitted to Saint Alphonsus Regional Medical Center in Boise, Idaho between 2013 and 2017, with diagnosed empyema by culture positive pleural fluid during their hospital stay (n=109). Data collected included length of hospitalization, length of intensive care unit stay and length of mechanical ventilation, all compared to pathogen isolated and surgical vs non-surgical interventions. Statistical analysis was performed with ANOVA by Wizard statistical software RESULTS: Data analyzed from 109 cases with culture positive pleural fluid showed there was a significantly larger number of hospital days for those requiring surgery to chest tube drainage only (15.1 vs 11.9 p=0.034), but no increase in the number of ICU days (7.7 vs 4.8 p=0.092). ICU stays were shorter for those receiving intrapleural fibrinolytics (4.4 vs 8.5 p=0.045). However, number of ventilator days did not change for those receiving intrapleural fibrinolytics (1.8 vs 2.8 p=0.6520). There was no difference in length of hospital stay between those who did and did not get intrapleural “lytics” (12.5 vs 14.3 p=0.388). When compared to all culture data, Staphylococcus epidermidis was associated with an increased number of hospital days (21.4 vs 12.7 p=0.003), longer ICU stays (18 vs 5.2 p<0.001), and longer ventilator days (11 vs 1.6 p<0.001). Longer ICU stays were also associated with candida species (14.8 vs 5.7 p=0.044). Initial gram stain was not associated with any statistical differences in hospital days, ICU length of stay, or ventilator days. CONCLUSIONS: Intrapleural fibrinolytics are associated with shorter intensive care unit stays but not overall shorter hospital stays. The need for surgical intervention results in a significantly longer hospital course regardless of initial pleural “lytics” or not. Staphylococcus epidermidis appears to have virulence factors making pleural infections by this organism particularly problematic. CLINICAL IMPLICATIONS: Intrapleural fibrinolytics may not have as broad a role in clinical practice as they are commonly being used given the length of hospital stays. Though there may still be a definite role for them in patients sick enough to require the ICU. Given Staphylococcus epidermidis’ longer lengths of stay, consideration for early surgical intervention with this organism might not be unreasonable. DISCLOSURES: No relevant relationships by Joshua Holweger, source=Web Response No relevant relationships by Martine Troy, source=Web Response