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Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors

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@article{675c89a8bc30417a9d4f5dbe003b0306,
title = "Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors",
abstract = "BACKGROUND: 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.METHODS: Data from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively.RESULTS: Microbiology, 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).CONCLUSIONS: No 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.",
keywords = "Aged, Anti-Bacterial Agents/therapeutic use, Bacterial Infections/mortality, Comorbidity, Denmark/epidemiology, Drainage/methods, Empyema, Pleural/microbiology, Female, Humans, Intensive Care Units/statistics & numerical data, Logistic Models, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors",
author = "Meyer, {Christian Niels} and Karin Armbruster and Michael Kemp and Thomsen, {Trine Rolighed} and Dessau, {Ram Benny} and {Danish Pleural Empyema group}",
year = "2018",
month = "10",
day = "12",
doi = "10.1186/s12890-018-0726-1",
language = "English",
volume = "18",
pages = "160",
journal = "BMC Pulmonary Medicine",
issn = "1471-2466",
publisher = "BioMed Central Ltd",
number = "1",

}

RIS

TY - JOUR

T1 - Pleural infection

T2 - a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors

AU - Meyer, Christian Niels

AU - Armbruster, Karin

AU - Kemp, Michael

AU - Thomsen, Trine Rolighed

AU - Dessau, Ram Benny

AU - Danish Pleural Empyema group

PY - 2018/10/12

Y1 - 2018/10/12

N2 - BACKGROUND: 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.METHODS: Data from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively.RESULTS: Microbiology, 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).CONCLUSIONS: No 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.

AB - BACKGROUND: 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.METHODS: Data from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively.RESULTS: Microbiology, 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).CONCLUSIONS: No 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.

KW - Aged

KW - Anti-Bacterial Agents/therapeutic use

KW - Bacterial Infections/mortality

KW - Comorbidity

KW - Denmark/epidemiology

KW - Drainage/methods

KW - Empyema, Pleural/microbiology

KW - Female

KW - Humans

KW - Intensive Care Units/statistics & numerical data

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Retrospective Studies

KW - Risk Factors

KW - Severity of Illness Index

KW - Time Factors

U2 - 10.1186/s12890-018-0726-1

DO - 10.1186/s12890-018-0726-1

M3 - Journal article

VL - 18

SP - 160

JO - BMC Pulmonary Medicine

JF - BMC Pulmonary Medicine

SN - 1471-2466

IS - 1

ER -

ID: 56441660