Fraser Brims1,2, Natalia Popowicz1,3,4, Andrew Rosenstengel1, Julie Hart5, Arthee Yogendran1, Catherine A Read1, Felicity Lee1, Ranjan Shrestha1, Alexander Franke1, Joshua R Lewis6, Ian Kay7, Grant Waterer4,8, Y C Gary Lee1,4. 1. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia. 2. Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. 3. School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia. 4. Institute for Respiratory Health, University of Western Australia, Perth, WA, Australia. 5. Microbiology, PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia. 6. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia. 7. Microbiology, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia. 8. Department of Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia.
Abstract
BACKGROUND AND OBJECTIVE: Pleural infection is a clinical challenge; its microbiology can be complex. Epidemiological and outcome data of pleural infection in adult Australians are lacking. We describe the bacteriology and clinical outcomes of Australian adults with culture-positive pleural infection (CPPI) over a 6-year period. METHODS: Cases with CPPI were identified through Western Australian public hospitals electronic record. Culture isolates, admission dates, vital status, co-morbidities, radiology, blood and pleural fluid tests were extracted. RESULTS: In total, 601 cases (71.4% males; median age: 63 years (IQR: 50-74); median hospital stay 13 days) involving 894 bacterial isolates were identified. Hospital-acquired (HA)-CPPI was defined in 398 (66.2%) cases, community-acquired (CA)-CPPI in 164 (27.3%) cases and the remaining classified as oesophageal rupture/leak. Co-morbidities, most frequently cancer, were common (65.2%). Radiological evidence of pneumonia was present in only 43.8% of CA-CPPI and 27.3% of HA-CPPI. Of the 153 different bacterial strains cultured, Streptococcus species (32.9%) especially viridans streptococci group were most common in CA-CPPI, whereas HA-CPPI was most often associated with Staphylococcus aureus (11.6%) and Gram-negative (31.9%) infections. Mortality was high during hospitalization (CA-CPPI 13.4% vs HA-CPPI 16.6%; P = 0.417) and at 1 year (CA-CPPI 32.4% vs HA-CPPI 45.5%; P = 0.006). CONCLUSION: This is the first large multicentre epidemiological study of pleural infection in Australian adults and includes the largest cohort of HA-CPPI published to date. CPPI is caused by a diverse range of organisms which vary between CA and HA sources. CPPI is a poor prognostic indicator both in the short term and in the subsequent 12 months.
BACKGROUND AND OBJECTIVE:Pleural infection is a clinical challenge; its microbiology can be complex. Epidemiological and outcome data of pleural infection in adult Australians are lacking. We describe the bacteriology and clinical outcomes of Australian adults with culture-positive pleural infection (CPPI) over a 6-year period. METHODS: Cases with CPPI were identified through Western Australian public hospitals electronic record. Culture isolates, admission dates, vital status, co-morbidities, radiology, blood and pleural fluid tests were extracted. RESULTS: In total, 601 cases (71.4% males; median age: 63 years (IQR: 50-74); median hospital stay 13 days) involving 894 bacterial isolates were identified. Hospital-acquired (HA)-CPPI was defined in 398 (66.2%) cases, community-acquired (CA)-CPPI in 164 (27.3%) cases and the remaining classified as oesophageal rupture/leak. Co-morbidities, most frequently cancer, were common (65.2%). Radiological evidence of pneumonia was present in only 43.8% of CA-CPPI and 27.3% of HA-CPPI. Of the 153 different bacterial strains cultured, Streptococcus species (32.9%) especially viridans streptococci group were most common in CA-CPPI, whereas HA-CPPI was most often associated with Staphylococcus aureus (11.6%) and Gram-negative (31.9%) infections. Mortality was high during hospitalization (CA-CPPI 13.4% vs HA-CPPI 16.6%; P = 0.417) and at 1 year (CA-CPPI 32.4% vs HA-CPPI 45.5%; P = 0.006). CONCLUSION: This is the first large multicentre epidemiological study of pleural infection in Australian adults and includes the largest cohort of HA-CPPI published to date. CPPI is caused by a diverse range of organisms which vary between CA and HA sources. CPPI is a poor prognostic indicator both in the short term and in the subsequent 12 months.
Authors: Tamsin N Cargill; Maged Hassan; John P Corcoran; Elinor Harriss; Rachelle Asciak; Rachel M Mercer; David J McCracken; Eihab O Bedawi; Najib M Rahman Journal: Eur Respir J Date: 2019-10-01 Impact factor: 16.671
Authors: José M Porcel; Lucia Ferreiro; Laura Rumi; Esther Espino-Paisán; Carmen Civit; Marina Pardina; Juan Antonio Schoenenberger-Arnaiz; Luis Valdés; Silvia Bielsa Journal: Pleura Peritoneum Date: 2020-02-26