Parapneumonic effusion and thoracic empyema in adults. Clinical aspects, microbiology and frequency of surgical outcome.

Abstract

To date, information about the outcome of patients with parapneumonic effusion and empyema is limited. To describe the clinical characteristics, the microbiological study and the frequency and type of surgical treatment in adult patients with parapneumonic effusion or empyema. A prospective cross-sectional study of patients admitted with parapneumonic effusion or empyema, from August 2011 to July 2014, in a reference hospital for respiratory diseases in Mexico City, was conducted. Clinical characteristics, microbiology, risk categories for poor prognosis in empyema and frequency and type of surgical treatment were studied. We studied 284 patients whose median age was 47 years, 75% were men, and 57.7% were transferred from other hospitals. In 38.5% of the cases a microorganism was identified and there was a predominance of Gram negative. 153 (53.9%) required surgical treatment, of which 90% were thoracotomy with decortication. Hospital mortality was 5.63%. Most of the patients arrived in advanced stages of the disease, so more than half required surgery, of which 90% was decortication. It is desirable to favor mechanisms for early diagnosis and treatment to reduce the need for surgical treatment.