Kate Birkenkamp1, John C O'Horo2, Rahul Kashyap3, Ben Kloesel1, Brian D Lahr4, Craig E Daniels5, Francis C Nichols6, Larry M Baddour7. 1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. 2. Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. Electronic address: OHoro.John@mayo.edu. 3. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA. 4. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. 6. Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA. 7. Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Abstract
OBJECTIVES: Empyemas require aggressive antimicrobial and surgical management. However, the specifics of antimicrobial therapy have not been studied in clinical trials. The present study examines management and outcomes among a cohort of patients with empyema cared for in a tertiary-care referral hospital over a decade. METHODS: We retrospectively identified patients hospitalized with empyema from January 2000 through December 2010 at one institution. Patient demographics, laboratory findings, treatments, and patient outcomes were abstracted using a standard form. Data were summarized with standard descriptive statistics. RESULTS: A total of 91 patients were identified. The predominant organisms were viridans group streptococci, which were isolated in 64% of cases with cultures. The median length of hospitalization was 9 days. Length of antimicrobial therapy from time of source control was variable, with a median (interquartile range) duration of 27 (15-31) days. Of note, longer courses of parenteral, but not oral, therapy were associated with fewer cases of clinical failure. CONCLUSIONS: This descriptive analysis demonstrated a higher rate of viridans group streptococci than expected. Three weeks of therapy was generally adequate and prevented clinical failure, but further study is needed with a much larger cohort to better define the optimal drug regimen, route, and duration of antimicrobial therapy for empyema.
OBJECTIVES: Empyemas require aggressive antimicrobial and surgical management. However, the specifics of antimicrobial therapy have not been studied in clinical trials. The present study examines management and outcomes among a cohort of patients with empyema cared for in a tertiary-care referral hospital over a decade. METHODS: We retrospectively identified patients hospitalized with empyema from January 2000 through December 2010 at one institution. Patient demographics, laboratory findings, treatments, and patient outcomes were abstracted using a standard form. Data were summarized with standard descriptive statistics. RESULTS: A total of 91 patients were identified. The predominant organisms were viridans group streptococci, which were isolated in 64% of cases with cultures. The median length of hospitalization was 9 days. Length of antimicrobial therapy from time of source control was variable, with a median (interquartile range) duration of 27 (15-31) days. Of note, longer courses of parenteral, but not oral, therapy were associated with fewer cases of clinical failure. CONCLUSIONS: This descriptive analysis demonstrated a higher rate of viridans group streptococci than expected. Three weeks of therapy was generally adequate and prevented clinical failure, but further study is needed with a much larger cohort to better define the optimal drug regimen, route, and duration of antimicrobial therapy for empyema.
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