Development Of Empyema Research Articles

Diaphragmatic Injury with Empyema Development after Microwave Ablation of a Liver Dome Lesion.

Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the diaphragm and lung parenchyma. In this report, we present a case of diaphragmatic injury and subsequent empyema following MWA of a liver dome lesion.

Coexistence of COVID-19, Pseudomonas, and thoracic actinomycosis in a cystic bronchiectasis case

Actinomycosis often leads to cervicofacial infections, but thoracic involvement may also occur. However, the development of empyema is rare. While being followed up with the diagnosis of asthma and bronchiectasis, our case was hospitalized for infected bronchiectasis. As empyema developed in the follow-up, the pleural effusion was drained by tube thoracostomy. Actinomycosis was diagnosed through pleural effusion cytology. Growth of Pseudomonas aeruginosa was observed in sputum culture, and SARS-CoV2 RT-PCR was also positive in nasopharyngeal sampling. Polymicrobial agents can often be detected in actinomycosis. Actinomycosis cases have also been reported in the post-COVID period. Our case is presented since it would be the first in the literature regarding the coexistence of COVID-19, Pseudomonas, and thoracic Actinomycosis (empyema).

Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report

Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae. A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment. Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial.

Surgical Treatment of Bronchopleural Fistulas on the Background of Pleural Empyema

Pleural empyema (EP) is one of the most complex nosologies of thoracic surgery. Mortality in this disease reaches 28% according to the literature. The causes of the development of nonspecific empyema of the pleura are various purulent-destructive lung diseases, as well as inflammatory diseases, surgical interventions and injuries. The presence or absence of bronchopleural fistula (BPS) is crucial in determining the prognosis of treatment of pleural empyema. This article is devoted to the study of the issues of surgical treatment of BPS against the background of various EP variants. Objective. To evaluate the effectiveness of using fibrin glue as a regeneration stimulator in the treatment of patients with bronchopleural fistulas on the background of pleural empyema. Materials and methods. In the I. V. Davydovsky State Clinical Hospital No. 23, for the treatment of patients with EP complicated by the development of bronchopleural fistula, an integrated approach is used using the concept of biological stimulation of tissue repair through the use of fibrin glue obtained by cryoprecipitation. Results. Our experience based on the study of 136 patients with pleural empyema of various etiologies (post-pneumonic (n=76), post-resection (n=11), covid-associated (n=49)) shows encouraging results. The clinical efficacy of using fibrin glue as a stimulator of tissue repair was 91,89% in the group of post-pneumonic EP, 66,66% in the group of post-resection EP and 90,9% in the group of covid-associated EP. However, the results obtained require further analysis and study.Conclusion. Despite the achievements of recent decades in antibiotic therapy, the improvement of surgical techniques and new minimally invasive methods of treatment, the problem of the development of bronchopleural fistulas remains relevant to this day. Knowledge of the issues of pathogenesis, risk factors, as well as the improvement of therapeutic tactics in the development of this formidable complication will increase the effectiveness of treatment and improve the prognosis of this category of patients. The use of biological stimulators of tissue repair based on own blood plasma may be a promising direction of treatment of this complex pathology.

ANALYSIS OF POSTOPERATIVE COMPLICATIONS IN THE TREATMENT OF PATIENTS WITH LUNG CANCER

Summary. The aim of the study. Based on the analysis of the nature and course of postoperative complications in the treatment of patients with lung cancer, to improve the results of surgical treatment of this category of patients.
 Materials and methods. The results of the analysis of postoperative complications of 363 patients with lung cancer who were treated in the oncological department of the thoracic cavity of the clinic of the Communal Non-Commercial Enterprise «Regional Center of Oncology» in Kharkiv for the period from 2017 to 2021 are presented. There were 234 men (64.6 %) , women - 128 (35.4 %), the age of patients ranged from 43 to 84 years, the average age was (59.8±2.4 years). All patients underwent radical surgery for primary lung cancer. Lobectomies were performed most often. In this volume, 296 patients were operated on, which was 81.5 %. Pneumonectomy was performed on 51 patients, which was 14.1 %. Anatomical segmentectomy was performed in 16 patients (4.4 %). Postoperative complications and factors causing them were analyzed.
 Research results and their discussion. The main complications typical for the postoperative period of lung cancer patients are highlighted. Complications in the postoperative period occurred in 10.5 % of patients. Complications related to failure of bronchus stump sutures and tracheobronchial tree anastomoses occurred in 8 patients (2.2 %). In two patients, this led to the development of pleural empyema and death.Thanks to early diagnosis, 4 patients underwent rethoracotomy, bronchus stump suturing, resection or final pneumonectomy.
 Cardiovascular complications (acute myocardial infarction, acute cardiovascular failure, stroke, pulmonary embolism) were found in 5 patients (1.4 %). 3 patients died of stroke, acute myocardial infarction and acute cardiovascular failure. Two patients survived, and one of them was diagnosed with Pulmonary embolism (PE), COVID-19 and bilateral pneumonia.
 Postoperative mortality was 2.5 % (9 patients died). Two patients (0.6 %) died from failure of the bronchus stump sutures, which led to empyema of the pleura. Two patients (0.6 %) died from the consequences of intrapleural bleeding. Another 2 (0.6 %) patients died of acute myocardial infarction. One patient each (0.3 %) died of stroke, postoperative pneumonia, and pericux abscess, which led to empyema of the pleura.
 Conclusions. The surgical method of treating patients with lung cancer remains the main one despite the number of postoperative complications, the majority of which are «non-surgical». Analysis of the nature and course of postoperative complications in the treatment of patients with lung cancer, and the improvement of the method of determining functional operability, made it possible to reduce the frequency of complications and form a concept for improving the results of surgical treatment of this category of patients.

WHEN FLU LEADS THE WAY: A CASE OF PARVIMONAS MICRA POLYMICROBIAL EMPYEMA IN A PATIENT WITH INFLUENZA A INFECTION

WHEN FLU LEADS THE WAY: A CASE OF PARVIMONAS MICRA POLYMICROBIAL EMPYEMA IN A PATIENT WITH INFLUENZA A INFECTION

Risk of Pleural Empyema in Adult Patients With Asthma: A Nationwide Retrospective Cohort Study

BackgroundRespiratory system infections commonly occur among individuals with asthma. However, whether asthma patients have a higher risk of pleural empyema development remains unclear.MethodsThis is a retrospective cohort study based on data from the National Health Insurance Research Database of Taiwan. The asthma cohort consisted of 48,360 newly diagnosed adult individuals from 2000 to 2012. The comparison cohort consisted of the same number of adults who did not have asthma and was matched for age, gender, comorbidity, and the year of diagnosis. The development of pleural empyema was followed up to 2013.ResultsPleural empyema incidence was 2.03-fold higher in the asthma cohort compared to the comparison cohort (8.65 vs. 4.25 per 10,000 person-years), with an adjusted hazard ratio (HR) of 2.12 [95% confidence interval (CI) = 1.76–2.56]. Stratified analyses by age, gender, comorbidity, and corticosteroid use revealed that the crude and adjusted HRs of pleural empyema associated with asthma were all significant. Among patients with asthma, the risk of pleural empyema elevated with increased frequency of annual asthma-related emergency room visits and hospital admissions (≥1 vs. <1, aHR = 8.07, 95% CI = 4.31–15.1 and aHR = 9.31, 95% CI = 5.56–15.6).ConclusionAn increased risk of pleural empyema occurrence was observed in adult patients with asthma than those without asthma. Furthermore, the risk of pleural empyema may increase with poor control of asthma.

The role of microbial factor in the development of complications after lung resection for tuberculosis

In most patients with pulmonary tuberculosis, timely surgical treatment gives good and even excellent results. However, complications that worsen the course of the postoperative period are still not uncommon. If we exclude the outbreak of a specific process in the operated lung and on the opposite side, then the most formidable complication is the development of pleural empyema.

Outcomes of patients discharged home with a chest tube after lung resection: a multicentre cohort study.

Background:Prolonged air leaks are increasingly treated in the outpatient setting, with patients discharged with chest tubes in place. We evaluated the incidence and risk factors associated with readmission, empyema development and further interventions in this patient population.Methods:We undertook a retrospective cohort analysis of all patients from 4 tertiary academic centres (January 2014 to December 2017) who were discharged home with a chest tube after lung resection for a postoperative air leak lasting more than 5 days. We analyzed demographics, patient factors, surgical details, hospital readmission, reintervention, antibiotics at discharge, empyema and death.Results:Overall, 253 of 2794 patients were analyzed (9.0% of all resections), including 30 of 759 from centre 1 (4.0%), 67 of 857 from centre 2 (7.8%), 9 of 247 from centre 3 (3.6%) and 147 of 931 from centre 4 (15.8%) (p < 0.001). Our cohort consisted of 56.5% men, and had a median age of 69 (range 19–88) years. Despite similar initial lengths of stay (p = 0.588), 49 patients (19.4%) were readmitted (21%, 0%, 23% and 11% from centres 1 to 4, respectively, p = 0.029), with 18 (36.7%) developing empyema, 11 (22.4%) requiring surgery and 3 (6.1%) dying. Only chest tube duration was a significant predictor of readmission (p < 0.001) and empyema development (p = 0.003), with a nearly threefold increased odds of developing empyema when the chest tube remained in situ for more than 20 days.Conclusion:Discharge with chest tube after lung resection is associated with serious adverse events. Given the high risk of empyema development, removal of chest tubes should be considered, when appropriate, within 20 days of surgery. Our data suggest a potential need for proactive postdischarge outpatient management programs to diminish risk of morbidity and death.

PLASTY OF A LARGE THROUGH THORACIC WALL DEFECT WITH THE HELP OF VRAM-FLAP: A CLINICAL CASE

At present, there is a fairly large number of surgical interventions, both open and video-assisted thoracoscopic, on the chest organs in oncopathology and pulmonary tuberculosis, as well as in various pyoinflammatory and nonspecific diseases of the lungs and pleura. However, a consequence of the increase in surgical activity is an increase in the number of postoperative complications, the most severe of which are bronchopleural complications. The management of patients with inadequate sealing after lung resection is one of the most common problems in thoracic surgery. Thoracostomy is still actively used in patients with a long-term residual pleural cavity with a volume of more than 1 / 3 of the hemithorax, with the ineffectiveness of the measures taken to achieve aerostasis (change of active and passive aspiration, pneumoperitoneum, chemical pleurodesis), in the absence of the effect of closed drainage, videothoracoscopy, and with the further development of empyema. Thus, surgical treatment of lung pathology on the background of local infectious process and delayed lung expansion on the background of COPD is largely associated with the risk of complications. One of them is the empyema of the pleura, which, in this clinical case, was complicated by severe osteomyelitis of the ribs, requiring several thoracoplasties with the appearance of large thoracostomy. One of the methods for treatment of such defects is flap plastics. In the presented clinical case, thoracostomy surgery of the right hemitorax was performed with a vertical flap on the rectus abdominis (VRAM-flap).

Risk factors related to pleural empyema after talc slurry pleurodesis

ObjectiveEmpyema is a complication of talc-pleurodesis that may lead to further surgical intervention and death. Therefore, the present study's objective was to identify the risk factors for the development of post-pleurodesis empyema after talc slurry pleurodesis in order to better select patients for this procedure and minimize its morbidity. MethodsPatients with malignant pleural effusion who underwent talc slurry pleurodesis at the present institution from January 2018 to January 2020 were retrospectively analyzed. Post-pleurodesis empyema was defined as pleural infection up to 30 days after pleurodesis. Using Cox regression analysis, significant prognostic factors for the development of empyema were examined. ResultsOf the 86 patients identified for inclusion in the study, 62 were women (72%). Their mean age was 56.3±12.6 years. The median pleural drainage time was 9 days, and 20 patients (23.3%) developed empyema. In the univariate analysis, both drainage time (p = 0.038) and the use of antibiotics prior to pleurodesis (p < 0.001) were risk factors for pleural empyema. Multivariate analysis also identified the use of antibiotics as an independent risk factor (Odds Ratio [OR] 9.81; 95% Confidence Interval [95% CI] 2.87‒33.54). Although the pulmonary expansion was not associated with empyema in the multivariate analysis, patients with less than 50% pulmonary expansion had a 4.5-times increased risk of empyema (95% CI 0.90‒22.86; p = 0.067), and patients with 50‒70% pulmonary expansion had a 3.8-times increased risk of empyema (95% CI 0.98‒15; p = 0.053) after pleurodesis. ConclusionThe study suggests that antibiotic therapy prior to talc slurry pleurodesis may increase the risk of developing empyema. Furthermore, pleurodesis should be considered with caution in patients with long-duration chest tube placement and incomplete lung expansion.

ДИАГНОСТИКА И ЛЕЧЕНИЕ ПОЗДНО ВЫЯВЛЕННОЙ ЭМПИЕМЫ ПЛЕВРЫ У ПОДРОСТКА

Delayed detection of tuberculous pleurisy results in the development of pleural empyema, which requires complex treatment involving surgery. The article describes a clinical observation illustrating diagnosis, clinical features, and treatment of tuberculous pleural empyema in an adolescent.Keywords: TB, empyema, adolescent, complication, treatment, surgical intervention.

Development of Subdural Empyema from Subdural Effusion after Suppurative Encephalitis

Development of Subdural Empyema from Subdural Effusion after Suppurative Encephalitis

The use of transdermal therapeutic systems for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer

This clinical observation demonstrates a method of a motivated use of a transdermal therapeutic system (TTS) based on fentanyl for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer. The most common complication after elective lung resections is an alveolar-pleural fistula or prolonged air leakage. This clinical phenomenon occurs as a result of communication between the alveoli of the lung parenchyma distal to the segmental bronchus and the pleural cavity. In most cases, air leakage through the drains is eliminated spontaneously, but the frequency of prolonged pneumostasis absence in the postoperative period can reach 25 %, which has a negative effect on the outcomes of surgical interventions due to the development of pneumonia and empyema. Long-term drainage of the pleural cavity does not always end with aerostasis and requires repeated invasive interventions. One of the ways to achieve the tightness of the lung tissue involves various methods of chemical pleurodesis, which is a surgical manipulation – the introduction of a sclerosing chemical substance into the pleural cavity by spraying medical talc through a trocar or a injecting tetracycline solution into the pleural drains. The chemical causes aseptic inflammation and adhesions between the visceral and parietal pleura, followed by obliteration of the pleural cavity. The sclerosant introduction is accompanied by severe pain that can provoke respiratory and/or hemodynamic deficits, up to apnea and life-threatening heart rhythm disturbances. Pain relief during chemical pleurodesis is obviously an important factor in the prevention of a number of complications in patients undergoing surgery for lung cancer. Bolus intravenous injections of narcotic analgesics lead to an analgesic effect, but a short-term one due to the absence of a depot in the body and a sharp drop in the drug concentration in the blood serum. Unfortunately, this method of introducing narcotic drugs can cause various complications in weakened and elderly cancer patients, such as respiratory depression and cardiac arrest. The TTS action is characterized with continuous dosing and the creation of a constant concentration of the narcotic drug over a certain period of time. This method provides a multilevel and systematic approach to pain relief, reduces toxicity and minimizes the inhibition of the central mechanisms of external respiration regulation without causing respiratory and cardiac disorders in patients who underwent lung resection.

Bacterial Profile of Bile Culture from Patients Undergoing Cholecystectomy

Laparoscopic cholecystectomy is the most commonly performed routine surgical operation in general surgery. There is a debate about utility of prophylactic antibiotic therapy following cholecystectomy. The aim of the study was to investigate bacterial growth in bile culture from patients after laparoscopic cholecystectomy. Methods. This study included 80 patients who undergone laparoscopic cholecystectomy. All gallbladder specimens were sent for histopathology. A bile sample from each case was cultured on Brain heart infusion broth, MacConkey agar, and chocolate agar. Analytical profile indices were used for identification of isolated bacteria. Results. Six histopathological abnormalities were detected, of which chronic cholecystitis was the most common abnormality (58.75%) followed by acute cholecystitis with mucocele (11.25%). Thirty one bile samples (38.75%) were positive for bacterial growth. The overall bacterial isolates from bile samples showed Escherichia coli, 13.75%, Pseudomonas aeruginosa, 8.75%, Enterococcus faecium, 5%, Citrobacter freundii, 3.7%, Staphylococcus epidermidis, 3.75%, Lactobacillus gasseri, 2.5% and Bifiidobacterium, 1.25%. Bacterial colonization of gallbladder was significantly associated with acute cholecystitis with mucocele and empyema. Conclusions. More than one third of patients with cholelithiasis are positive for bacterial culture. Bacterial infection of stoned gallbladder associated with the development of empyema. Thus, prophylactic antibiotic therapy is recommended for patients undergoing cholecystectomy due to gallbladder stone.

FIBROTHORAX DUE TO STREPTOCOCCUS INTERMEDIUS INFECTION IN A 24-YEAR-OLD PATIENT WITH DOWN SYNDROME

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fibrothorax occurs as a long-term complication of untreated pleural infections. Well-known causes of fibrothorax include recurrent parapneumonic effusions, empyema, and frank hemorrhage in the pleural space. Here we present a case of massive fibrothorax secondary to silent aspiration pneumonias in a patient with Down's syndrome. CASE PRESENTATION: A 24-year-old male with Down's syndrome and autism presents with a complaint of right-sided back pain and fever for two days. The patient is non-verbal at baseline but is able to communicate with his mother, who is the primary caregiver. He has a fixed routine throughout the day, owing to his autism, and his mother takes excessive precautions in tracking his symptoms and keeping his healthcare appointments.In the ER, the patient was hypoxic and tachypneic; initially requiring non-invasive ventilation, and subsequently mechanical ventilation with admission to the ICU. Work-up including chest radiograph revealed complete opacification of the right hemithorax, while the CT chest revealed a large right-sided pleural effusion, consolidation, and a thick pleural peel. Broad-spectrum antibiotics were initiated, and the patient subsequently underwent a right-sided VATS and lung decortication. Intraoperative findings revealed massive fibrothorax without frank pus. Blood and respiratory cultures were negative, surgical culture from pleural peel, however, grew Streptococcus intermedius (S. intermedius). Pathology demonstrated granulation tissue with abundant adherent fibrin and fibrinopurulent exudate, compatible with empyema. On day 7, he was transferred out of the ICU after showing marked clinical improvement. DISCUSSION: Diffuse pleural thickening or fibrothorax occurs due to severe pleural space inflammation. The development of empyema is an uncommon complication, with a reported incidence of 2-3% of all pneumonias. We hypothesize the etiology in our patient to be attributed to recurrent silent aspirations in a patient with Downs syndrome. Anatomical and functional abnormalities including macroglossia, poor neuromotor control, and gastroesophageal reflux make these patients aspiration-prone, which quite often are silent. This is further supported by the presence of S. intermedius in the pleural culture. This bacterium is commonly found in the oral flora but has been associated with brain, liver and thoracic empyema. Recent literature review revealed a limited number of reported cases of pneumonia caused by S. intermedius. Decortication is an effective strategy for treating symptomatic patients, regardless of cause, when significant underlying parenchymal disease has been excluded, as was done in our patient. CONCLUSIONS: It is important for clinicians to be aware of uncommon causes of fibrothorax, such as seen in this case of recurrent silent aspirations, without recurrent pleural effusions, leading to strep intermedius-associated pleural fibrosis. REFERENCE #1: Hannoodi F, Ali I, Sabbagh H, Kumar S. Streptococcus intermedius Causing Necrotizing Pneumonia in an Immune Competent Female: A Case Report and Literature Review. Case Rep Pulmonol. 2016;2016:7452161. doi:10.1155/2016/7452161 REFERENCE #2: Huggins JT, Sahn SA. Causes and management of pleural fibrosis. Respirology. 2004 Nov;9(4):441-7. doi: 10.1111/j.1440-1843.2004.00630.x. PMID: 15612954 REFERENCE #3: Jackson A, Maybee J, Moran MK, Wolter-Warmerdam K, Hickey F. Clinical Characteristics of Dysphagia in Children with Down Syndrome. Dysphagia. 2016 Oct;31(5):663-71. doi: 10.1007/s00455-016-9725-7. Epub 2016 Jul 12. PMID: 27405422 DISCLOSURES: No relevant relationships by Timothy Barreiro, source=Web Response No relevant relationships by Rishanki Jha, source=Web Response No relevant relationships by Oyidiya Osoka, source=Web Response

MPN-280: Transfusion Independence Achieved with Combination Fedratinib and Luspatercept in an Elderly Male with Heavily Pretreated INT-2 Primary Myelofibrosis

Context: Myelofibrosis (MF)-associated anemia and transfusion dependency are associated with inferior quality of life and poor prognosis. Combination JAK2 inhibitors and TGF-β superfamily ligand traps are being explored as treatment options for MF-associated anemia. Objective: To demonstrate the efficacy and tolerability of combination fedratinib and luspatercept in transfusion-dependent MF. Design: Case report. Setting: Academic referral center. Patients or Other Participants: 66-year-old male was diagnosed with JAK2-positive PMF 8 years ago. IPSS at diagnosis was 0 (low-risk group). After 3 years of observation, he developed worsening anemia. Repeat bone marrow biopsy showed stable hypercellularity and reticulin fibrosis without increased myeloid blasts. DIPSS-PLUS score placed him in the INT-2 risk group. Interventions: Ruxolitinib yielded a 50% reduction in spleen size. However, it resulted in worsening anemia and transfusion dependence, leading to dose reduction, followed by discontinuation. The patient declined evaluation for bone marrow transplantation. He was then enrolled in a clinical trial for pacritinib, which resulted in the stabilization of splenomegaly without improvement in transfusion requirements. Pacritinib was discontinued after the development of empyema and drug-induced pneumonitis. Darbepoetin alfa was initiated without improvement in transfusion requirements. Ultimately, he was started on fedratinib 300 mg daily, then 400 mg daily, without significant side effects. Four months later, luspatercept 1 mg/kg every 3 weeks was added to fedratinib. Main Outcome Measures: Transfusion independence and spleen size. Results: Spleen size decreased from 20 cm to 12 cm by palpation 5 months after starting fedratinib. Hemoglobin increased from a baseline of 6 g/dL to 8.9 g/dL 18 days after the first dose of luspatercept. 8 months after the initiation of luspatercept, hemoglobin has stabilized around 11 g/dL. Luspatercept was held on several occasions due to hemoglobin >11.5 g/dL (highest 11.8 g/dL). The patient had significant improvement in his performance status and is now working full time. Conclusions: Combination fedratinib and luspatercept is a promising therapy for anemia in patients with transfusion-dependent INT-2 MF. Currently, 3 clinical trials are evaluating luspatercept alone (NCT03194542) or in combination with a JAK2 inhibitor (NCT04717414 and NCT03755518) for the treatment of MF-associated anemia. No grant was received for this article.

Transpleural Сontralateral Occlusion of the Left Main Bronchus Stump &#x0D; in a Patient with Bronchopleural Fistula and Chronic Pleural Empyema

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and the pleural cavity, the most common complication of anatomical lung resection.BPF rarely closes spontaneously and almost always requires surgical or bronchoscopic interventions.The main methods of treatment are sanitation of the pleural cavity with the development of empyema and re-occlusion of the bronchial stump. The development of this complication in the postoperative period is accompanied by an increase in hospitalization time, a high risk of chronic pleural empyema, exacerbation of chronic diseases and death. The mortality rate ranges from 18 to 67%. Most often, BPF is manifested after removal of the right lung (8-13%), compared with the left side (1-5%), which is due to the anatomical features of the main bronchus.The presented clinical case describes a non-standard surgical approach in the treatment of bronchopleural fistula and chronic empyema of the residual pleural cavity in a young patient.

C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia

Objectives: To explore the negative predictive value (NPV) of C-reactive protein (CRP) at admission to exclude complicated disease manifestations of pneumococcal disease.Methods: A Dutch multicentre retrospective cohort study was conducted between 01-01-2012 and 30-06-2020. Adults with positive blood cultures for Streptococcus pneumoniae, whose CRP was measured at admission and whose infection focus was known, were included. Electronic medical and microbiological records were reviewed.Results: Of the 832 bacteraemic patients enrolled, 30% had complicated manifestations of pneumococcal disease; most frequent were pleural effusion (8.9%), pleural empyema (5.4%) and meningitis (7.5%). Compared to solitary pneumonia, patients with pleural effusion and empyema presented with higher CRP levels. Although low CRP levels did not exclude complicated disease in general, a CRP level < 114 mg/L at admission could reliably exclude empyema among adult pneumonia patients with an NPV of 93% and a specificity of 26%. However, in cases where pleural fluid was present, CRP levels were mostly > 114 mg/L, such that suspicion of empyema could only be ruled out in a minority of cases (10%).Conclusions: Complicated manifestations are prevalent in adult pneumococcal bacteraemia. Low blood CRP levels can reliably exclude the development of pulmonary empyema. Practical value may be largest in settings without thoracic imaging at hand.

Autologous blood patch pleurodesis for prolonged postoperative air leaks.

BackgroundA prolonged air leak (PAL) is the most frequent complication after pulmonary resection. This study aimed to assess the safety and efficacy of autologous blood patch pleurodesis (ABPP) to treat PAL.MethodsA prospectively maintained database identified patients with a PAL after pulmonary resection for lung cancer between 2015–2019. In this observational cohort study, clinical data were collected to retrospectively compare patients undergoing ABPP to no ABPP in a propensity-matched analysis. Kaplan Meier estimates and Cox models accounting for inverse probability weighting (IPTW) were used to assess the association of ABPP with each outcome.ResultsOf the 740 patients undergoing lung resection, 110 (15%) were identified as having a PAL at postoperative day (POD) 5. There was no difference between baseline characteristics among those undergoing ABPP (n=34) versus no ABPP (n=76). Propensity-weighted analysis did not reveal a significant association of ABPP treatment with in-hospital complication (P=0.18), hospital length of stay (LOS) (P=0.13), or post-discharge complication (P=0.13). However, ABPP treatment was associated with a lower risk of hospital readmission [P=0.02, hazard ratio (HR) 0.16] and reoperation for air leak or empyema (P=0.05, HR 0.11). Although not statistically significant, the mean chest tube (CT) removal of 11 days for the ABPP group was less than the no ABPP group (16 days) (P=0.14, HR 1.5–2). Those treated with ABPP were less likely to be discharged with a CT (ABPP 7/34, 21% vs. no ABPP 40/76, 53%). There was no statistical difference in empyema development between groups (ABPP 0/34, 0% vs. no ABPP 4/76, 5%, P=0.39, HR 0.24).ConclusionsABPP administration is safe compared to traditional PAL management. In a retrospective propensity-matched analysis, postoperative patients treated with ABPP required less readmission and reoperation for PAL. Larger powered randomized trials may demonstrate the magnitude of benefit from treatment with ABPP.