SESSION TITLE: New Developments in the Diagnosis and Management of Mycobacterial and Bacterial Chest Infections SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Therapeutic drainage with tube thoracostomy has been shown to be a safe and effective treatment of parapneumonic pleural effusions and empyema. Previous animal studies have shown that late chest tube placement (>72 h) is deleterious compared to those animals that underwent early chest tube placement (24 or 48 h). Oftentimes, drainage options are variable between clinicians and institutions provoking a delayed chest tube placement after the diagnosis is made. In this study we aim to determine the clinical outcomes of early chest tube insertion (<24 hours) in patients with complex parapneumonic pleural effusions and empyema. METHODS: We performed a retrospective analysis of the patients diagnosed with complicated parapneumonic pleural effusions and empyema that were treated with thoracostomy at BIDMC. Patients demographics, comorbidities, antibiotic treatment duration and outcomes were recorded. Clinical outcomes such as total antibiotic duration, all-cause mortality at 30 days, and need for need for intra-pleural fibrinolytic or surgery were compared between groups. RESULTS: A total of 182 patients were identified from the analysis (Age 72 years [IQR 63-83]; Body mass index 26.3 [IQR 23.3-30.2]; 120 males [65.93%]). Ninety-two (50.55%) had thoracostomy within the first 24 h after admission. Of the total, 160 patients (87.91%) had thoracostomy with chest tube size <14 Fr. The time from admission to thoracostomy was 1 day (IQR 0-4). Patients with late chest tube insertion had an increased total antibiotic duration (34 vs 27.5 days, p=0.012) and required further treatment more frequently (22.22% vs 11.96%; p=0.05). Thirty-three (36.67%) patients required VATS on the early chest tube group compared to 37 (40.22%) in the other group (p=0.28). Regarding hospital stay, patients who underwent early chest tube insertion had shorter stays compared with the other group (9.5 days vs 14.5 days, p=<0.001). There was no significant difference in terms of all-cause mortality at 30 days between groups. CONCLUSIONS: Our study suggest that early chest tube insertion decreases hospital stay, antibiotic treatment duration and the need for additional pleural interventions. CLINICAL IMPLICATIONS: Define the optimal timing for chest tube insertion in patients with complicated parapneumonic effusion and empyema. 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