To analyze pathogenesis, bacteriology, drainage methods and outcomes of thoracic empyema in one institution over a nineteen year period. (1986-2004).
Retrospective review of medical and microbiology records of thoracic empyema (culture positive pleural fluid and /or pus) and analysis of patient demographics, pathogenesis, bacteriology, drainage methods and outcome.
One hundred and twelve cases (culture + = 107, pus = 5) of empyema were identified. The patients were predominantly men over 45 yrs of age (45-65 yrs=52%, >65yrs =42%). Most common pathogenetic factors were post pneumonic in 66(60%) and post thoracotomy in 18(16%). Sixty percent of the empyemas were community-acquired and the remaining were hospital- acquired. The 107 culture positive cases yielded 154 bacterial isolates. Pleural fluid isolates showed only aerobes in 80 cases (74.8%) anaerobes alone or with aerobes in 27 cases (25.2%). The most common aerobes were staphylococci (38.6% of aerobic isolates) and streptococci (31.0%) followed by gram negative bacilli (17%) and Streptococcus pneumoniae (6.7%).The most common anaerobes isolated were Bacteroides (28.5% of anaerobic isolates), Fusobacterium (17%), peptostreptococcus (14.2%), diptheroids 4(11.4%) and micro-aerophilic streptococci (8.5%). In all cases appropriate antibiotics were given. The initial drainage procedure employed was closed chest tube in 91 patients (20 required subsequent surgical procedures) and thoracotomy in 13 patients. Eight patients were drained by thoracentesis alone. Eighty one (72.3%) patients were cured, 9 patients (8%) died of empyema and 22 patients (19.6 %) with co-morbid conditions died while empyema was active.
Most empyemas are postpneumonic and in a quarter of cases anaerobes are the causative microbes. Closed chest tube drainage is effective in most cases but additional surgical procedures may be needed in 20%. Mortality due to empyema was 8%; however a larger number of patients with co-morbid conditions died.
Information on patient demographics, pathogenetic mechanisms, bacteriology, treatment and outcome of empyema from this large series may be useful in devising better treatment and improving outcome.
Manish Joshi, None.