Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
Introduction: Infection of pleural space that arises due to complicated parapneumonic effusion and empyema is a common worldwide problem that is known since very ancient times. The microbial aetiology of pleural space infections has changed since introduction of antibiotics. Gram positive organi...
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| Autores principales: | , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/e1009ee3932340918ddcb74e92b9cc24 |
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| Sumario: | Introduction: Infection of pleural space that arises due to
complicated parapneumonic effusion and empyema is a common
worldwide problem that is known since very ancient times. The
microbial aetiology of pleural space infections has changed since
introduction of antibiotics. Gram positive organisms are slowly
and steadily losing their foothold in the pleural space to the
more resilient and resistance gram negative bacteria. Incidence
of these infections are increasing and delayed treatment causes
significant morbidity and mortality.
Aim: To study the age-sex profile, symptoms, microbiological
findings, aetiology, management and treatment outcome of pleural
space infections.
Materials and Methods: This cohort study was conducted at
Veer Surendra Sai Institute of Medical Sciences and Research,
Burla, Odisha, India, from November 2016 to October 2017 on
48 consecutive patients. Each patient was followed-up for a
minimum period of two months. The demographic data, clinical
presentation, microbiological findings, aetiology, clinical course
and management information were collected in a predesigned
proforma and analysed.
Results: The study population comprised of 33 (68.8%) male,
15 (31.2%) female patients. The mean age of the study population
was 46±14 years. The most common presenting complaints were
fever {43 (89.5%)}, shortness of breath {42 (87.5%)}, chest pain
{38 (79.1%)} and cough {36 (75%)}. Pneumonia was diagnosed
in 30 (62.5%) cases as the major cause of pleural space infection.
Common organisms isolated were Streptococcus pneumoniae
11 (23%), Streptococcus pyogenes 9 (18.7%), Staphylococcus
aureus 7 (14.5%) and Escherichia coli 7 (14.5%). The treatment
was with Intravenous (i.v.) antibiotics followed by oral antibiotics.
Most cases 46 (95.8%) required both thoracocentesis and
Intercostal Tube Drainage (ICTD). Follow-up chest X-ray after two
weeks showed complete lung expansion in 25 (52%) cases. Pleural
thickening of <2 cm found in 22 (45.8%) cases and >2 cm found in
26 (54.2%) cases. At the end of one month of discharge 35 (73%)
patient had complete resolution, 8 (16.7%) patients had persistent
infection, 3 (6.2%) died and 2 (4.1%) patients were loss to followup. Out of the eight patients with persistent infection one patient
had empyema necessitans and seven patients had bronchopleural
fistula. On follow up after 2nd month out of the 8 (16.6%) persistence
cases, 5 (10.4%) cases were cured and remaining 3 (6.2%) cases
the infection persisted (pus) and ICTD was kept in-situ.
Conclusion: Pneumonia is the most common cause of pleural
space infections. Most common pathogen isolated was gram
positive organism Streptococcus pneumoniae. In significant
number of cases gram negative organism Escherichia coli was
isolated. Most cases required both thoracocentesis and ICTD
for resolution. The key to successful management of pleural
infection remains to be early diagnosis, initiation of empirical
broad spectrum antibiotics, followed by specific antimicrobial
therapy after microbial identification and drug sensitivity testing. |
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