PARAPNEUMONIC PLEURAL EFFUSION AND EMPYEMA: MICROBIOLOGICAL ASSESSMENT AND TREATMENT STRATEGIES IN A HIGH-VOLUME PLEURAL CENTER

Abstract

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Parapneumonic effusion refers to the accumulation of fluid in the pleural space in the setting of an adjacent pneumonia. Furthermore, empyema refers to a collection of pus within the pleural space, which can develop when bacteria's, fungi, parasites, or mycobacteria invade the pleural space, either from an adjacent pneumonia, from direct inoculation or another source. We aim to characterize the pleural culture from patients with parapneumonic pleural effusions in terms of isolated microorganisms, antibiotic treatment and source of infection. METHODS: Retrospective medical records review of patients diagnosed with parapneumonic pleural effusion and empyema between 1998 and 2019 at Beth Israel Deaconess Medical Center were included. Patients were identified from our institutional database using the International Classification of Diseases 9th revision (ICD-9, codes 510.9 and 510.10) as well as the 10th revision (ICD-10, codes J86.0 and J86.9). RESULTS: Total of 598 subjects were included. Pleural fluid culture was obtained in 535 (89.5%) patients. Of those, 41.3% had a negative result, followed by polymicrobial etiology (9.5%), MSSA (8.2%), and Streptococcus viridans (8.2%). The most common antibiotics used were Vancomycin in 70.07% of patients, followed by Metronidazole (43.4%), Levofloxacin (36.0%), and Ceftriaxone (35.0%). The median total antibiotic duration was 31 days (IQR 20-44), the IV duration was 10 days (IQR 7-16), and further antibiotic treatment was required in 13.4% due to patient unresponsiveness to initial treatment. Regarding the source of infection, 54.4% of cases were community acquired followed by hospital acquired (32.4%) and post-surgical (8.2%). A total of 321 (53.68%) subjects had VATS. Thoracostomy was performed in 182 (30.43%) patients with 26% of those having a tube size <14 Fr. TPA/DNase therapy was used in 116 (19.4%) subjects and the median number of doses was 2 (IQR 1-3). All-cause mortality during the timeline of the study was 18.56% (n=111). CONCLUSIONS: Our large cohort of patients evidenced the high rate of negative results after pleural fluid culture, followed by polymicrobial etiology, supporting the use of broad-spectrum antibiotic therapy to cover gram positive, gram negative and anaerobic bacteria as a first line strategy. Furthermore, we found a high rate of patients requiring further antibiotic therapy due to initial unresponsiveness to treatment.Our large cohort of patients adds further evidence to the existing literature and helps to elucidate and optimize the antibiotic therapy and reduce failure rate. CLINICAL IMPLICATIONS: Microbiologic characterization of empyema and parapneumonic effusion is necessary for optimizing antibiotic therapy and reducing failure rate. DISCLOSURES: No relevant relationships by Ramsy Abdelghani, source=Web Response No relevant relationships by Alvaro Ayala, source=Web Response No relevant relationships by Alex Chee, source=Web Response No relevant relationships by Fayez Kheir, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Rachel Martinez, source=Web Response No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Priya Patel, source=Web Response No relevant relationships by Alichia Paton, source=Web Response No relevant relationships by Juan Pablo Uribe, source=Web Response