Abstract
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 4,715 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 yrs (p=0.012), alcoholism (p=0.002), pleuritic pain (p=0.002), tachycardia >100 beats·min−1 (p=0.006) and leukocytosis >15,000 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.
Footnotes
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Statement of Interest
None declared.
- Received January 1, 2011.
- Accepted April 12, 2011.
- ©ERS 2011