Abstract
BackgroundWe explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses.MethodsData from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively.ResultsMicrobiology, co-morbidity, therapy and outcome are described in detail. Patient groups with microbiology negative and known bacterial etiology had a similar 30-day and 90-day mortality. There were no differences in initial antibiotic treatment regimens, antibiotic treatment duration, rate of intra-pleural fibrinolysis treatment, surgical referral rate, and ICU admittance rate. Patients with microbiology negative etiology were younger (60.8 vs 64.3 years) and fewer had predisposing risk factors (59% vs 71%), but pleural drainage was more often delayed (49% vs 36%). Mortality was similar in patients treated with either of the two nationally recommended initial antibiotic regimens. However, higher 90-day mortality (22.5% vs 9.7%), disease severity (31.5% vs 6.2%), and ICU admittance rate (21.3% vs 2.9%) was observed in a sub-group with initial broad-spectrum treatment compared to patients receiving the nationally recommended initial treatments, irrespective of knowledge of etiology. Several factors correlated independently to 90-day mortality, including age, predisposing risk factors, surgical referral (Odds-Ratios > 1), drainage delay and intra-pleural fibrinolysis (ORs < 1).ConclusionsNo difference was found between patients with microbiology negative and known bacterial etiology regarding outcome or treatment parameters. Treatment factors and predisposing factors independently relating to mortality were found in the cohort. Broad-spectrum antibiotics were initially used for treatment of patients with more severe illness and poorer outcome.
Highlights
We explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses
The main results focus on differences in outcome or other important variables between cases with microbiology negative etiology and cases with known etiology, and are presented in Tables 1 and 2
The infection was hospital associated in 14% of cases, and 43% of the patients were treated with antibiotics before hospital admittance
Summary
We explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses. Recommended treatment consists of antibiotics and pleural drainage. An adequate initial antibiotic regimen takes into account the locally expected spectrum of bacterial etiology and the antibiotic susceptibility, but this specific information may not be present in up to 47% of cases with microbiology negative etiology due to recent outpatient antibiotic treatment or due to delayed in-hospital sampling [2,3,4]. An antibiotic treatment duration of 3–6 weeks has been recommended for pleural infection [1]. Treatment factors such as active pleural drain irrigation or intra-pleural treatment with a fibrinolytic agent plus DNase without routine use of active drain irrigation correlated to outcome [5, 6]. With a limited number of patients included at individual participating centers and not including all consecutive patients in trials, the possibility of patient selection bias cannot be excluded [6]
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