PT - JOURNAL ARTICLE AU - M. Falguera AU - J. Carratalà AU - S. Bielsa AU - C. García-Vidal AU - A. Ruiz-González AU - I. Chica AU - F. Gudiol AU - J.M. Porcel TI - Predictive factors, microbiology and outcome of patients with parapneumonic effusion AID - 10.1183/09031936.00000211 DP - 2011 Nov 01 TA - European Respiratory Journal PG - 1173--1179 VI - 38 IP - 5 4099 - http://erj.ersjournals.com/content/38/5/1173.short 4100 - http://erj.ersjournals.com/content/38/5/1173.full SO - Eur Respir J2011 Nov 01; 38 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 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.