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Clinical and bacterial characteristics in Danish adults with pleural
empyema
Karin Armbruster, Christian Niels Meyer, Michael Kemp, Trine Rolighed Thomsen, Alice Friis-Moeller, Ram Benny Dessau
Gentofte University Hospital, Roskilde Hospital, Odense University Hospital, Aalborg University, Hvidovre University Hospital,
Slagelse Hospital
Table 2. Microbiological findings by standard culture methods
Introduction
Nosocomia
l
Total
n=106 in % n=12 in %
Recent studies have focused on the changes in bacterial etiology and
the consequences for treatment of pleural infection.
Our aim was to supplement the microbiological data with further
identification of species using molecular methods and with further
information on clinical and therapeutic factors and risk factors in
patients with pleural infection.
Methods
Cases were identified prospectively in the clinical practice and by
combining ICD-diagnosis DJ860-869 and results of microbiology from
the laboratory information systems. Clinical and microbiology data are
presented of the first 157 patients (out of 425 cases) with pleural
infection, collected pro- and retrospectively from 8 Danish hospitals
(2008-2011). In a subgroup of cases, frozen samples were collected
prospectively for further direct identification by molecular methods:
cloning, standard 16S rRNA PCR, and three group specific primer pairs
(for identifying mixed infection) with RipSeq analysis of the PCR product
1.
Results
Among the 157 cases, males accounted for 66% and females 34%, with
a similar age range: median of 64 years (range 22-97, IQR 54-73).
Mortality was 10% and the median time from date of admission to death
was 24 days (range 2-89).
Risk factors were present in 64% of cases (n=110, table 1). In the
previous 2 months, 7% (n=11) had a history of thoracic trauma, 3,2%
(n= 5) had a history of thoracic intervention, and 5,7% (n=9) had simple
pleurocentesis performed.
Treatment included intra-pleural fibrinolysis in 35% of cases, and 11,6%
were referred for thoracic surgery (subgroup mortality 5,6%).
The length of in-hopital stay was median 16 days (range 1-73)
Streptococcus
anginosus/intermediu
s
Non-hemolytic
streptococci
Streptococcus
pneumoniae
Anaerobes
Hemophilus
influenzae
Staphylococcus
aureus
Staphylococcus
lugdunensis
Eschericia coli
Pseudomonas
aeruginosa
26
24.5
1
8.3
15
14.2
1
8.3
14
13.3
10
9.4
3
2.8
8
7.5
5
42
2
1.9
3
2.8
2
1.9
2
17
Among the106 culture positive cases, a simultaneous dry transportation
Proteus vulgaris
2
1.9
1
8.3
(in tubes) and liquid medium transportation (blood culture bottles) was
performedEnterobacter
in 16 cases, ofspecies
which 15 were
by
3 culture
2.8 positive
1
8.3both
methods and one was culture positive in blood culture bottles only.
Other bacteriae
18
17
1
8.3
Bacterial DNA was identified in 26 (of 73 samples analyzed, Table 3)
samples of which 15 were also culture positive. Particularly anaerobic
bacteria (Fusobacterium species, especially) were frequent among
PCR/RipSeq identified bacterial species (n= 24), which were not
identified by traditional culture.
Community acquired infections accounted for 82% of cases.
Table 3. Bacterial identification by culture vs. triple primer 16S rRNA
PCR and sequensing of the product (73 samples)
Table1. Risk-factors in patients with pleural infection
Cancer
(Pulmonary cancer)
n = 31
28,1%
(n=12,
39%)
Alcohol abuse
n = 27
24,5%
Diabetes mellitus
n = 13
11,8%
COPD
n = 11
10 %
General weakness
n = 10
9,1%
n = 18
16,5 %
Other
(neurological and
psyciatric disease etc.)
Culture and PCR-analysis
PCR-analysis positive only
positive
20,5%
(n=15)
15,1%
(n=11)
Culture
positive only
4,1%
Culture and
PCR-analysis
negative
(n=3)
60,3%
(n=44)
Conclusions
Treatment and outcome data, combined with microbiological and clinical
characteristic among patients with pleural infection are described, and
new data on microbiological identification using molecular methods are
presented; which identified additional micro-organisms compared to
traditional culture methods.
Reference:
1. Kommedal et al.: J Med Microbiol. 2011; 60: 927 – 36