Archive for February 23, 2014

The spectrum of pneumococcal empyema in adults in the early 21st century.

Clin Infect Dis 2011 Aug 1; 53(3) :254-61.

Burgos J, Lujan M, Falcó V, et al.

Institution

Infectious Diseases Department, Universitat Autònoma de Barcelona, Barcelona, Spain. jburgos@vhebron.net

BACKGROUND

Increased rates of empyema have been reported in children after the introduction of the pneumococcal conjugate vaccine (PCV7). Our objective was to describe the risk factors for pneumococcal empyema in adults and to analyze the differences in the incidence, disease characteristics, and serotype distribution between the pre- and post-PCV7 eras.

METHODS

An observational study of all adults hospitalized with invasive pneumococcal disease (IPD) who presented with empyema in 2 Spanish hospitals was conducted during the periods 1996-2001 (prevaccine period) and 2005-2009 (postvaccine period). Incidences of empyema were calculated. A multivariate analysis was performed to identify variables associated with pneumococcal empyema.

RESULTS

Empyema was diagnosed in 128 of 1080 patients with invasive pneumococcal disease. Among patients aged 18-50 years, the rates of pneumococcal pneumonia with empyema increased from 7.6% to 14.9% (P = .04) and the incidence of pneumococcal empyema increased from 0.5 to 1.6 cases per 100,000 person-years (198% [95% confidence interval {CI}, 49%-494%]). The incidence of empyema due to serotype 1 increased significantly from 0.2 to 0.8 cases per 100,000 person-years (253% [95% CI, 67%-646%]). Serotype 1 caused 43.3% of cases of empyema during the postvaccine period. Serotypes 1 (odds ratio [OR], 5.88; [95% CI, 2.66-13]) and 3 (OR, 5.49 [95% CI, 1.93-15.62]) were independently associated with development of empyema.

CONCLUSIONS

The incidence of pneumococcal empyema in young adults has increased during the postvaccine period, mainly as a result of the emergence of serotype 1. Serotypes 1 and 3 are the main determinants of development of this suppurative complication.

PDF

http://cid.oxfordjournals.org/content/53/3/254.full.pdf+html

February 23, 2014 at 3:57 pm

Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010.

Thorax 2010 Aug.:ii41-53.

Davies HE, Davies RJ, Davies CW, et al.

Institution

Oxford Centre for Respiratory Medicine, Churchill Hospital Site, Oxford Radcliffe Hospital, Oxford, UK.

abstract

http://thorax.bmj.com/content/65/Suppl_2/ii41.long

PDF

http://thorax.bmj.com/content/65/Suppl_2/ii41.full.pdf+html

February 23, 2014 at 3:55 pm

Pleural infection – Changing bacteriology and its implications.

Respirology 2011 May; 16(4) :598-603.

Lisboa T, Waterer GW, Lee YC

Critical Care Department and Infection Control Committee, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul and Intensive Care Unit, Hospital Santa Rita, Complexo Hospitalar Santa Casa, Porto Alegre, Brazil. tlisboa@hcpa.ufrgs.br

The incidence of pleural infection continues to rise worldwide. Identifying the causative organism(s) is important to guide antimicrobial therapy.

The bacteriology of pleural infection is complex and has changed over time.

Recent data suggest that the bacterial causes of empyema are significantly different between adult and paediatric patients, between community-acquired and nosocomial empyemas and can vary among geographical regions of the world.

Since the introduction of pneumococcal vaccines, a change has been observed in the distribution of the serotypes of Streptococcus pneumoniae in empyema. These observations have implications on therapy and vaccine strategies.

Clinicians need to be aware of the local bacteriology of empyema in order to guide antibiotic treatment.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1843.2011.01964.x/abstract

PDF

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1843.2011.01964.x/pdf

February 23, 2014 at 3:54 pm

Empyema – An increasing concern in Canada.

Can Respir J 2008 Mar; 15(2) :85-9.

Finley C, Clifton J, Fitzgerald JM, et al.

Division of Thoracic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. christianfinley@shaw.ca

BACKGROUND

Empyema is a suppurative infection of the pleural space. Without prompt treatment, it can result in significant hospital stays, more invasive treatments as it progresses, and substantial morbidity and mortality.

OBJECTIVES

The primary objective of the present study was to evaluate whether there has been an increasing incidence of empyema in Canada. A secondary objective was to investigate whether this increase disproportionately affects any age group.

METHODS

The Discharge Abstract Database of the Canadian Institute for Health Information was used to evaluate national empyema data.

RESULTS

There were 11,294 patients identified with empyema over the nine-year period of the present study, of whom 31% were women. The mean (+/- SD) length of stay was stable throughout the study at 21.82+/-33.88 days, and 63.4% were discharged home. The incidence rate ratio (IRR) was defined as the ratio of the incidence rate of medical empyema in 2003 divided by the incidence rate in 1995. Medical empyema increased significantly (IRR 1.30, 95% CI 1.20 to 1.41; P<0.001), as did empyema of unknown cause (IRR 1.29, 95% CI 1.08 to 1.54; P=0.005), while surgical empyema did not appear to increase (IRR 1.17, 95% CI 0.97 to 1.43; P=0.114). A Poisson regression showed an increase in the indirect age-standardized IRR during the study period (IRR 1.025, 95% CI 1.018 to 1.032; P<0.001). The IRR for patients younger than 19 years of age from 1995 to 2003 was 2.20 (95% CI 1.56 to 3.10), while the IRR in patients older than 19 years was 1.23 (95% CI 1.14 to 1.34).

CONCLUSIONS

The present study demonstrates the increasing rate of empyema in Canada and shows a change in pattern of disease. The disproportionate rate change in the pediatric population suggests a high-risk group that needs to be addressed. In the adult population, while cause is unknown, it is necessary to continually educate front-line physicians to confront both the increased burden of this disease, caused by an aging population, and the underlying increasing rate of empyema in Canada.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677840/pdf/crj15085.pdf

February 23, 2014 at 3:51 pm

Neumonía adquirida en la comunidad con pleuritis explosiva

Anales de Medicina Interna Agosto 2005 V.22 N.8

Carta al Editor

E. M. Fonseca Aizpuru, F. J. Nuño Mateo, L. Otero Guerra1, C. López de Mesa2

Servicios de Medicina Interna y 1Microbiología. 2Unidad de Cuidados Intensivos. Hospital de Cabueñes, Gijón. Oviedo

Sr. Director:

El estreptococo del grupo A es un hallazgo frecuente en casos de faringoamigdalitis, que tambien es responsable de infecciones en otras localizaciones, como en la piel y tejidos blandos, y de forma excepcional se encuentra produciendo neumonías y bacteriemia.

Presentamos el caso de una paciente con neumonía complicada con empiema del que se aisló Streptococcus pyogenes….

FULL TEXT

http://scielo.isciii.es/scielo.php?pid=S0212-71992005000800017&script=sci_arttext

February 23, 2014 at 3:50 pm


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