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Disorders of the Pleura |

Pleural Space Infections: Microbiologic Characteristics in 165 Patients

Rosa Palma, MD; Silvia Bielsa, MD; José Porcel, MD
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Arnau de Vilanova University Hospital, Lleida, Spain


Chest. 2014;145(3_MeetingAbstracts):273A. doi:10.1378/chest.1824320
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Abstract

SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Parapneumonic effusions and empyemas are becoming an increasingly frequent clinical problem worldwide, and may have substantial morbidity and mortality. Identification of causative microorganisms is essential for an appropriate empirical treatment. Our objective was to determine the bacterial etiologies of parapneumonic pleural effusions and empyemas in our geographical area.

METHODS: Retrospective review of all patients admitted to our hospital over a 17-year period with parapneumonic pleural effusions or empyemas, in whom a bacterial microorganism was isolated from a standard culture on pleural fluid specimens.

RESULTS: A total of 184 organisms were identified in the pleural fluid of 165 patients. The majority of isolates were Gram-positive organisms (65%), namely Streptococcus viridans (n=47), Streptococcus pneumoniae (n=25) and Staphylococcus aureus (n=18). Enterobacteriaceae (n=26, 16%) were the most common Gram-negative aerobic pathogens, while anaerobic organisms were registered in 13 (8%) cases. A single bacteria was recovered in 171 (93%) patients, while 2 microorganisms were found in 11 patients, and 3 in the last 2. Streptococcus viridans most frequently presented in polimicrobial infections (9 of 13), whereas Streptococcus pneumoniae was identified only as a pure isolate. Pleural fluid purulence was more common with Streptococcus viridans (77%), Enterococcus (82%) and anaerobic pathogens (85%) (χ2=0.01).

CONCLUSIONS: Gram-positive aerobic microorganisms are the most common isolated pathogens from pleural fluid in parapneumonic effusions and empyemas. Streptococcus viridans, Enterococcus and anaerobics are most commonly associated with purulent pleural fluids. The low incidence of anaerobic isolates may largely be due to defective collection and/or processing of the pleural fluid specimens, as well as the methods of detection.

CLINICAL IMPLICATIONS: Empirical treatment of parapneumonic effusions and empyemas should always cover Gram-positive microorganisms.

DISCLOSURE: The following authors have nothing to disclose: Rosa Palma, Silvia Bielsa, José Porcel

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