RT Journal Article SR Electronic T1 The microbiology of pleural infection in adults: a systematic review JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 1900542 DO 10.1183/13993003.00542-2019 A1 Maged Hassan A1 Tamsin Cargill A1 Elinor Harriss A1 Rachelle Asciak A1 Rachel M. Mercer A1 Eihab O. Bedawi A1 David J. McCracken A1 Ioannis Psallidas A1 John P. Corcoran A1 Najib M. Rahman YR 2019 UL http://erj.ersjournals.com/content/early/2019/06/26/13993003.00542-2019.abstract AB Background and objectives Pleural infection is a major cause of morbidity and mortality among adults. Identification of the offending organism is key to appropriate antimicrobial therapy. It is not known whether the microbiological pattern of pleural infection is variable temporally or geographically. This systematic review aimed to investigate available literature to understand the worldwide pattern of such microbiology and the factors that might affect such pattern.Data sources and eligibility criteria Ovid Medline and Embase were searched between 2000 and 2018 for publications that reported on the microbiology of pleural infection in adults. Both observational and interventional studies were included. Studies were excluded if the main focus of the report was paediatric population, tuberculous empyema, or post-operative empyema.Study appraisal and synthesis methods studies of 20 or more patients with clear reporting of microbial isolates were included. The numbers of isolates of each specific organism/group were collated from the included studies. Besides the overall presentation of data, subgroup analyses by geographical distribution, infection setting (community versus hospital), and time of the report was carried out.Results From 20 980 reports that the initial search returned, 75 papers reporting on 10 241 patients were included in the data synthesis. The most common organism reported worldwide was Staphylococcus aureus. Geographically, Pneumococci and Viridans Streptococci were the most commonly reported isolates from tropical and temperate regions, respectively. The microbiological pattern was considerably different between community- and hospital-acquired infections where more gram-negative and drug-resistant isolates were reported in the hospital-acquired infections. The main limitations of this systematic review were the heterogeneity in the method of reporting of certain bacteria and the predominance of reports from Europe and South East Asia.Conclusions In pleural infection, the geographical location and the setting of infection have considerable bearing on the expected causative organisms. This should be reflected in the choice of empirical antimicrobial treatment.Systematic review registration number CRD42017076418FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Hassan has nothing to disclose.Conflict of interest: Dr. Cargill has nothing to disclose.Conflict of interest: Dr. Harriss has nothing to disclose.Conflict of interest: Dr. Asciak has nothing to disclose.Conflict of interest: Dr. Mercer has nothing to disclose.Conflict of interest: Dr. Bedawi has nothing to disclose.Conflict of interest: Dr. McCracken has nothing to disclose.Conflict of interest: Dr. psallidas has nothing to disclose.Conflict of interest: Dr. Corcoran has nothing to disclose.Conflict of interest: Dr. Rahman has nothing to disclose.