Author(s): Meyer CN, Rosenlund S, Nielsen J, FriisMller A
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Abstract BACKGROUND: Our aims were to describe the aetiologies of culture-positive pleural infections and to evaluate the choice of empiric antimicrobial treatment regimens according to antimicrobial sensitivity, and to evaluate the possible influence of this on outcome. METHODS: All cases over a 9-y period were identified from 3 hospitals using the laboratory databases of the clinical microbiology departments, and were verified by evaluating the medical records. RESULTS: We identified 291 isolates in pleural fluid cultures from 158 patients. These included viridans streptococci (25\%), Staphylococcus aureus (18\%), anaerobic bacteria (17\%), Enterobacteriaceae (12\%), Staphylococcus epidermidis (10\%), and Streptococcus pneumoniae (7\%), with differences between nosocomial and community-acquired infections. The mortality (overall 27\%) was highest among the patients with Enterobacteriaceae (50\%) and S. aureus (36\%) infections, and in patients with mixed infections (34\%). The actual empiric treatment or the recommended penicillin plus metronidazole had low antimicrobial coverage (49\%) compared to the proposed cefuroxime plus metronidazole (78\%). Thoracentesis was often delayed (median 2 days). The adequacy of empiric antimicrobial therapy was independently correlated with mortality (odds ratio 0.43, 95\% confidence interval 0.30-0.62). CONCLUSIONS: The early diagnosis of pleural infection could be optimized. In this North-European patient population, we suggest that the recommended empiric antimicrobial treatment be changed to cefuroxime plus metronidazole for community-acquired and nosocomial infections.
This article was published in Scand J Infect Dis
and referenced in Journal of Pulmonary & Respiratory Medicine