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Empyema
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Joseph Sujka, Shawn D. St Peter
Diagnosis usually follows a progressive clinical picture beginning with pneumonia. Patients with an empyema demonstrate some degree of malaise, persistent fever, respiratory distress, and pleuritic chest pain. Physical exam should exhibit diminished breath sounds with dullness to percussion on the affected side. Ileus, with a lack of appetite, is common.
Acute Infective Endocarditis and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Less than 5% of native valve endocarditis are right sided. Tricuspid valve infection results in septic emboli to the lung. Symptoms include fever, cough, hemoptysis, and pleuritic pain. Empyema may complicate these infections. Only 5% of patients with right-sided disease have a murmur [10].
Empyema from Misplacement of Percutaneous Nephrostomy Tube—A Diagnostic Challenge
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Raed Abdulkareem, Francis J. Podbielski
Empyema is defined as an accumulation of purulent fluid in the pleural space and is most commonly secondary to pneumonia or a lung abscess. Empyema can however arise in other conditions as well. In this case report, we discuss the development of an empyema due to percutaneous nephrostomy tube placement. In this instance, the nephrostomy tube was found to be traversing the pleural space and diaphragm resulting in bacterial tracking from a chronically infected kidney into the pleural space with resultant empyema. Nephrostomy tube placement is a common procedure employed to manage several different types of ureteral obstruction. Complications of nephrostomy tube placement are rare and most commonly include bleeding, sepsis, organ injury, and death. Multiple reports appear in the literature describing these complications, but based on our literature review, no other cases were found in which a nephrostomy tube traversing the thoracic cavity en route to the kidney resulted in an empyema.
Indwelling tunneled pleural catheters in patients with hepatic hydrothorax: A single-center analysis for outcomes and complications
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2023
Fatmah F. Alhabeeb, Katia Carle-Talbot, Natalie Rakocevic, Tinghua Zhang, Michael Mitchell, Kayvan Amjadi, Chanel Kwok
Follow-up data collection included the presence of complications, categorized as catheter site infection, tunnel infection, fluid leak at the site of insertion leading to removal and empyema. Catheter site infection was defined as cellulitis at the IPC exit site requiring systemic antibiotics, while tunnel infection was defined as an infection in the IPC tunnel tract that extends for more than 2 cm from the catheter exit site. Empyema was defined as an infection of the pleural space confirmed by positive pleural fluid cultures or frank pus requiring subsequent intervention such as antibiotics, IPC removal and hospitalization. If clinically indicated, repeat pleural fluid analysis was performed in patients with suspected infectious complications to establish/confirm the diagnosis and to identify the causative organism.
Pharmacokinetics of antibiotics for pleural infection
Published in Expert Review of Respiratory Medicine, 2022
Estee P M Lau, Calvinjit Sidhu, Natalia D Popowicz, Y. C. Gary Lee
Recent years have seen new staging nomenclature of pleural infection, namely simple parapneumonic effusion, complex parapneumonic effusion and empyema which is determined by pleural fluid testing results. Simple parapneumonic effusion refers to the early stage of exudative fluid accumulation and the pleural fluid is characterized by a pH of >7.20, normal glucose levels, and absence of microorganisms in microbiologic testing [6]. Complex parapneumonic effusion (CPPE) is characterized by low pH (<7.20) and glucose in the pleural fluid and are often associated with high lactate dehydrogenase (LDH) levels and an abundance of neutrophils [6]. Empyema is diagnosed when pus (or in some papers, bacteria) is present in the pleural fluid. Pleural infection is a term that encompasses the cases of CPPE and empyema, as both generally require fluid drainage.
Oral step-down therapy in patients with uncomplicated Staphylococcus aureus primary bacteremia and catheter-related bloodstream infections
Published in Journal of Chemotherapy, 2022
Seok Jun Mun, Si-Ho Kim, Kyungmin Huh, Sun Young Cho, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck
Two patients with recurrence were identified in the IAT group. One patient experienced recurrent SAB caused by phlebitis after 85 days from initial positive blood culture. The other patient relapsed with empyema after 25 days from the initial positive blood culture. All-cause 90-day deaths were identified in eight patients (one in OAT and seven in IAT), but none were SAB-related deaths. Rates of treatment failure were 3.2% (1/32) in the OAT group and 12.7% (9/71) in the IAT group, respectively. Kaplan-Meier curves of treatment failure showed no significant difference between groups (P = 0.113) (Fig. 2). Otherwise, the length of hospital stay was significantly shorter in the OAT group compared to the IAT group (median eight and 15 days, P < 0.001). The Charlson comorbidity index (CCI) was significantly associated with treatment failure in the univariable analysis (Table 3). In the multivariable analysis including MRSA, female, age, metastatic solid cancer, OAT, and CCI, CCI was the only significant risk factor (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.01–1.49, P = 0.036). OAT was not significantly associated with treatment failure (aHR: 0.22, 95% CI: 0.03–1.73, P = 0.148).