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:	Sonali Das, Deepak Kumar Swain, Pravati Dutta, Rama Chandra Sethy
Formato:	article
Lenguaje:	EN
Publicado:	JCDR Research and Publications Private Limited 2021
Materias:	empyema lung abscess parapneumonic effusion Medicine R
Acceso en línea:	https://doaj.org/article/e1009ee3932340918ddcb74e92b9cc24
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spelling	oai:doaj.org-article:e1009ee3932340918ddcb74e92b9cc242021-11-11T18:14:30ZMicrobial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study10.7860/JCDR/2021/50769.153442249-782X0973-709Xhttps://doaj.org/article/e1009ee3932340918ddcb74e92b9cc242021-09-01T00:00:00Zhttps://www.jcdr.net/articles/PDF/15344/50769_CE[Ra1]_F(SHU)_PF1(AG_SHU_KM)_PN(KM).pdfhttps://doaj.org/toc/2249-782Xhttps://doaj.org/toc/0973-709XIntroduction: 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.Sonali DasDeepak Kumar SwainPravati Dutta Rama Chandra SethyJCDR Research and Publications Private Limitedarticleempyemalung abscessparapneumonic effusionMedicineRENJournal of Clinical and Diagnostic Research, Vol 15, Iss 9, Pp OC01-OC04 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	empyema lung abscess parapneumonic effusion Medicine R
spellingShingle	empyema lung abscess parapneumonic effusion Medicine R Sonali Das Deepak Kumar Swain Pravati Dutta Rama Chandra Sethy Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
description	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.
format	article
author	Sonali Das Deepak Kumar Swain Pravati Dutta Rama Chandra Sethy
author_facet	Sonali Das Deepak Kumar Swain Pravati Dutta Rama Chandra Sethy
author_sort	Sonali Das
title	Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
title_short	Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
title_full	Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
title_fullStr	Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
title_full_unstemmed	Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study
title_sort	microbial aetiology and clinical course of pleural space infections in a tertiary care hospital- a cohort study
publisher	JCDR Research and Publications Private Limited
publishDate	2021
url	https://doaj.org/article/e1009ee3932340918ddcb74e92b9cc24
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Microbial Aetiology and Clinical Course of Pleural Space Infections in a Tertiary Care Hospital- A Cohort Study

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