Predictive factors, microbiology and outcome of patients with parapneumonic effusion
| Autor: | F Gudiol, I Chica, Silvia Bielsa, Agustín Ruiz-González, Carolina Garcia-Vidal, Miquel Falguera, José M. Porcel, Jordi Carratalà |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Pleural effusion Parapneumonic effusion Risk Factors Internal medicine Acute care Pneumonia Bacterial medicine Humans Leukocytosis Empyema Pleural Aged business.industry Incidence (epidemiology) Middle Aged Prognosis bacterial infections and mycoses medicine.disease Empyema Anti-Bacterial Agents respiratory tract diseases Surgery Community-Acquired Infections Pleural Effusion Pneumonia Baseline characteristics Female medicine.symptom business |
| Zdroj: | European Respiratory Journal. 38:1173-1179 |
| ISSN: | 1399-3003 0903-1936 |
| DOI: | 10.1183/09031936.00000211 |
| Popis: | We aimed to determine the incidence, clinical consequences and microbiological findings related to the presence of pleural effusion in community-acquired pneumonia, and to identify predictive factors for empyema/complicated parapneumonic effusion. We analysed 4,715 consecutive patients with community-acquired pneumonia from two acute care hospitals. Patients were classified into three groups: no pleural effusion, uncomplicated parapneumonic effusion and empyema/complicated parapneumonic effusion. A total of 882 (19%) patients had radiological evidence of pleural fluid, of whom 261 (30%) met criteria for empyema/complicated parapneumonic effusion. The most important event related to the presence of uncomplicated parapneumonic effusion was a longer hospital stay. Relevant clinical and microbiological consequences were associated with empyema/complicated parapneumonic effusion. Five independent baseline characteristics could predict the development of empyema/complicated parapneumonic effusion: age60 yrs (p = 0.012), alcoholism (p = 0.002), pleuritic pain (p = 0.002), tachycardia100 beats·min⁻¹ (p = 0.006) and leukocytosis15,000 mm⁻³ (p0.001). A higher incidence of anaerobes and Gram-positive cocci was found in this subgroup of patients. We conclude that only the development of empyema/complicated parapneumonic effusion carried relevant consequences; this condition should be suspected in the presence of some baseline characteristics and managed by using antimicrobials active against Gram-positive cocci and anaerobes. |
| Databáze: | OpenAIRE |
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