Author(s): Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH,
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Abstract BACKGROUND: Antibiotic choices for pleural infection are uncertain as its bacteriology is poorly described. METHODS: Pleural fluid from 434 pleural infections underwent standard culture and a screen for bacteria by amplification and sequencing of bacterial 16S ribosomal RNA gene. RESULTS: Approximately 50\% of community-acquired infections were streptococcal, and 20\% included anaerobic bacteria. Approximately 60\% of hospital-acquired infections included bacteria frequently resistant to antibiotics (methicillin-resistant Staphylococcus aureus, 25\%; Enterobacteriaceae, 18\%; Pseudomonas spp., 5\%, enterococci, 12\%). Mortality was increased in hospital-acquired infection (hospital, 17/36 [47\%]; community, 53/304 [17\%]; relative risk, 4.24; 95\% confidence interval, 2.07-8.69; p < 0.00001; chi(2), 1 df = 17.47) and in gram-negative (10/22 [45\%]), S. aureus (15/34 [44\%]), or mixed aerobic infections (13/28 [46\%]), compared with streptococcal infection (23/137 [17\%]) and infection including anaerobic bacteria (10/49 [20\%]; p < 0.00001, chi(2), 4 df = 23.35). CONCLUSION: Pleural infection differs bacteriologically from pneumonia and requires different treatment. Antibiotics for community-acquired infection should treat aerobic and anaerobic bacteria. Hospital-acquired, gram-negative S. aureus and mixed aerobic infections have a high mortality rate.
This article was published in Am J Respir Crit Care Med
and referenced in Journal of Pulmonary & Respiratory Medicine