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Staphylococcus aureus
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
In the presence of bloodstream infections, retention of infected foreign bodies is associated with increased mortality rate and removal is indicated. Soft tissue infections with abscesses require drainage, and similarly, the mainstay of treatment of pleural empyema and iliopsoas abscess is drainage.
Diagnostic Reasoning and Clinical Problem Solving
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The typical CAP, particularly S. pneumoniae, presents with fever/chills ± pleuritic chest pain. On chest exam, there are localized rales; one/two lobe cavitation should suggest an alternative etiology, e.g., aspiration during abscess (subacute onset) occurring after 3–5 days. The only cause of rapid cavitation (<72 hours) and acute/severe CAP is MSSA/MRSA CAP only in patients with influenza. If present, CAP with pleural effusion is typically unilateral and most common with H. influenzae (RLL). With S. pneumoniae, pleural empyema (resembling pleural effusion on CXR) is usual and pleural effusion is uncommon. If present, pleural effusion due to S. pneumoniae is small whereas that due to H. influenzae is mild to moderate in size. Dullness may also be due to consolidation.
Pleural space problems
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Konrad Hoetzenecker, Walter Klepetko
Pleural empyema is, by definition, a collection of pus within the naturally existing anatomical cavity of the pleura. It is, in most cases, a sequela of a pneumonitis that has gained contact to the pleural cavity. According to demographic studies, it accounts for six out of 100 000 hospitalizations in the United States, with a twofold increase within the last 10 years. Although pleural empyema is a rare clinical condition, it has a high mortality of 7.2%o.1
Does the time to diagnosis and treatment influence outcome in adults with pleural infections
Published in European Clinical Respiratory Journal, 2023
Mads Brögger Klausen, Christian Laursen, Morten Bendixen, Babu Naidu, Eihab O Bedawi, Najib. M. Rahman, Thomas Decker Christensen
An important limitation of the study is that the several studies highlighting new aspects of the pathogenesis leading to pleural infection as well as a new prognostic scoring system for pleural infection has been published following the publication of most of the included studies in this review [24]. The classical description of the different stages in development of pleural empyema, as well the terms simple and complicated parapneumonic effusions, are based on a pathogenesis involving bacterial spread to the pleural cavity from the lung tissue. Recent studies have, however, demonstrated the need to consider more complex pathogeneses since a significant proportion of the patients with culture positive pleural empyema seem to have primary pleural infection rather than spread of the infection from the lung [25]. Furthermore, several studies have described and subsequently, prospectively validated clinical risk prediction scoring systems in adult patients with pleural infection [4]. The studies indicate the need for a revision of the classical dogma within the field of pleural infection, including studies assessing the integrated use of validated outcome scoring systems to guide treatment decisions. Since previously published studies primarily use the classical descriptions and stratification of pleural infection, it is not yet possible to conduct a systematic review based on the more recent studies.
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
Thus far, there are very limited data on pharmacokinetics of clinically relevant antibiotics used in pleural infection. Currently available literature includes small patient numbers, with the largest study, reporting ofloxacin, consisting of only 21 patients. Human pharmacokinetics of commonly recommended antibiotics including amoxicillin/clavulanate acid, cefuroxime and metronidazole are not currently available or for some agents including clindamycin and ciprofloxacin are reported in a limited number of patients. Such small sample size may not be taken as a representative of the wider population and can only act as an estimate. Nevertheless, these pharmacokinetic data can provide us with some idea of the penetration properties of an antibiotic into the infected pleural fluid. For example, pleural penetration of aminoglycosides was satisfactory in uninfected pleural effusions but not in the pus of empyema, as observed from the ratio of maximum drug concentration (Cmaxpleural fluid/serum) and area under the drug concentration time curve (i.e. degree of penetration of a drug in the pleural space, AUCpleural fluid/serum) of pleural fluid and serum. Their inactivation at lower pH renders them unsuitable for use in pleural infection. On the contrary, limited data suggests that some antibiotics from the cephalosporins, penicillin, and quinolones classes appear to penetrate sufficiently into pleural empyema.
16S rRNA is a valuable tool in finding bacterial aetiology of community-acquired pleural empyema–a population-based observational study in South Sweden
Published in Infectious Diseases, 2022
Jakob Hjertman, Jonas Bläckberg, Oskar Ljungquist
Community-acquired pleural empyema is a disease of significant morbidity and mortality, with 30-day mortality rates of 9–13% previously reported [1–5]. Risk factors include diabetes mellitus, immunosuppression, intravenous drug use, alcohol misuse and gastro-oesophageal reflux [6]. The incidence of pleural empyema has been estimated to 6–12 cases per 100 000 person-years and several studies have described an increasing incidence [3,4,7,8]. The treatment of pleural empyema involves systemic antimicrobial treatment, pleural drainage and in certain cases intrapleural fibrinolytic treatment and/or surgery [6]. The aetiology of pleural empyema varies, both geographically and over time. It is important to have knowledge of the regional bacterial aetiology to be able to base recommendations of empirical antimicrobial treatment [9,10]. Common bacterial causes of pleural empyema include Streptococcus pneumoniae, Staphylococcus aureus and viridans streptococci [10]. Studies describing the aetiology of pleural empyema are absent in Sweden, and a few describes the aetiologies in the adjacent Nordic countries [11,12].