Complicated Pleural Effusion: 108 Cases in a Specialized Center

Abstract

Background: Complicated pleural effusion treatment is backed up by the recommendations found in international guidelines emphasizing the importance of prior knowledge of the local epidemiology in order to carry out an appropriate empirical treatment. Since at a regional level, there is scarce information about this pathology, we deem it necessary to describe the clinical, microbiological and therapeutic characteristics of our environment. Methods & Materials: We performed a descriptive retrospective study. Medical records from patients admitted during the period between April 2012 and August 2017 were examined. Those patients over 15 years old with a diagnosis of complicated pleural effusion were included (loculated pleural effusion, pH < 7,2, glucose < 60 mg/dL and LDH > 1000 IU/L, positive microbiology). A Microsoft Office Excel spreadsheet was used to calculate relative frequencies, measures of central tendency and dispersion. Results: The study included 108 patients, of which 76% were male. The predominant age range was between 15 and 30 years old (32.40%). Patients presented comorbidities in 52.70%, especially active smoking. Of the admitted ones 67.60% were referred for diagnosis and treatment. The predominant symptoms observed were pleural plain (70.80%) and fever (60.40%). Community acquired pneumonia (CAP) was presented as prevalent etiology (41.60%). More than one criterion of complicated effusion was seen in 34.20% of cases and positive pleural fluid culture was the most frequent one (54.60%). Staphylococcus aureus was isolated in 41 cases and 70.70% of them were methicillin-resistant. Initial empirical treatment was appropriate in 55.50% and therapy was directed in 71.30% according to the microbiological examinations. Ampicillin-sulbactam was the main antibiotic. The patients received an average of 16.50 days of intravenous antibiotics (range 0-47 days). The average hospital stay was of 21.40 days (range 5-57 days). Six deaths were recorded. Conclusion: The characteristics of our population were similar to those described in the bibliography. Although the main cause of pleural effusion was CAP, a non-negligible number of isolations were methicillin-resistant Staphylococcus aureus, which can be justified by the high number of patients referred from other institutions with prior instrumentation.