Epidemiology of pleural infections in Taiwan from 1997 through 2008

Abstract

Population-based data on pleural infections are limited. This study describes the temporal trends in the incidence, management and outcomes of pleural infections in Taiwan. The Taiwan National Health Insurance Research Database was used to analyse data on 26,385 patients with a first episode of pleural infection between 1997 and 2008. During the study period, the median age of the patients increased from 60 to 65 years. The majority of patients were men (75%); this proportion remained constant over time. The standardized annual incidence of pleural infection increased from 5.2 per 100,000 in 1997 and reached a plateau of 8.4 to 9.6 per 100,000 between 2002 and 2008. Over time, there was an increase in the use of computed tomography (from 47.3% in 1997-1998 to 59.4% in 2007-2008), pigtail catheters (from 1.5% to 18.9%), fibrinolytics (from 0.9% to 9.3%) and surgery (from 27.7% to 33.6%), to treat pleural infections. Furthermore, the use of life-support resources, including haemodialysis, mechanical ventilation and intensive care, also increased by 3.1%, 11.0% and 12.8%, respectively. Median hospital charges per patient increased by 63.6% over the 12 years. Although the proportion of patients with organ dysfunction (i.e. severe sepsis) increased from 26.5% to 47.7%, 30-day mortality decreased from 15.0% to 13.1% (P-value for trend = 0.001). These findings suggest that advances in the management of pleural infections and subsequent severe sepsis may have led to a reduction in the risk of short-term mortality in Taiwan.