RT Journal Article
SR Electronic
T1 Predictive factors, microbiology and outcome of patients with parapneumonic effusion
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj00002-2011
DO 10.1183/09031936.00000211
A1 M. Falguera
A1 J. Carratalà
A1 S. Bielsa
A1 C. García-Vidal
A1 A. Ruiz-González
A1 I. Chica
A1 F. Gudiol
A1 J.M. Porcel
YR 2011
UL http://erj.ersjournals.com/content/early/2011/04/20/09031936.00000211.abstract
AB 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 4715 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: age <60 years (p=0.012), alcoholism (p=0.002), pleuritic pain (p=0.002), tachycardia >100 beats/minute (p=0.006) and leukocytosis >15000·mm−3 (p<0.001). 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.