TY - JOUR T1 - Fungal empyema: an uncommon disease with high mortality JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2019.PA3844 VL - 54 IS - suppl 63 SP - PA3844 AU - Nidia Pestana Caires AU - Sara Campos Silva AU - Joao Eurico Reis AU - Rita Gerardo AU - Margarida Pinto AU - Carlos Flores AU - Joao Cardoso Y1 - 2019/09/28 UR - http://erj.ersjournals.com/content/54/suppl_63/PA3844.abstract N2 - Fungal infections have increased in the last few decades as a result of the use of broad-spectrum antibiotics and the growing number of immunocompromised patients (pts), which have led to changes in the saprophytic microorganisms usually isolated. Fungal empyema (FE) is still a rare entity, with a mortality rate of 70%. Retrospective analysis of fungal pleural effusions diagnosed in our hospital between 2015 and 2018. Aseptic sampling of pleural fluid was performed by thoracentesis, chest drainage (CT) or video-assisted thoracoscopic surgery (VATS). Seventeen fungal isolates were obtained from 15 pts (12 males, mean age 60±19 y). It presented with nonspecific symptoms (respiratory failure, dyspnea and fever). Three-months mortality rate of 53% and high length of stay (50±16 days). Twelve yeasts (3 non-Candida albicans), 3 Aspergillus species, 1 Saccharomyces cerevisiae and 1 Trichosporon asahii were isolated. Twelve pts (80%) had ≥1 immunodeficiency disease: surgery in the 4 weeks before (n=6), cancer (n=4), alcoholism (n=2) and hepatic transplant (n=1). CT placement and antifungal therapy were used in 10 pts (66%), the most being azole derivatives. Seven pts (46%) underwent VATS with wash. The mean overall survival was 375 days. Pts submitted to CT placement had a longer survival (mean 520 days, p=0.04), but no significant differences were found in those treated with antifungals (p=0.08) or VATS (p=0.06). In this series of cases, CT placement was the isolated procedure with the greatest impact on survival. The optimal treatment of FE is not yet defined, but combination of drugs can be used due to variable penetration of antifungals into the pleural cavity. The severity of FE and its consequences should not be underestimated.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA3844.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -