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Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors

BACKGROUND: We explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses. METHODS: Data from the medical records of a large cohort of 437 consecutive patients in 9 hospit...

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Autores principales: Meyer, Christian Niels, Armbruster, Karin, Kemp, Michael, Thomsen, Trine Rolighed, Dessau, Ram Benny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186131/
https://www.ncbi.nlm.nih.gov/pubmed/30314475
http://dx.doi.org/10.1186/s12890-018-0726-1
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author Meyer, Christian Niels
Armbruster, Karin
Kemp, Michael
Thomsen, Trine Rolighed
Dessau, Ram Benny
author_facet Meyer, Christian Niels
Armbruster, Karin
Kemp, Michael
Thomsen, Trine Rolighed
Dessau, Ram Benny
author_sort Meyer, Christian Niels
collection PubMed
description BACKGROUND: We explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses. METHODS: Data from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively. RESULTS: Microbiology, co-morbidity, therapy and outcome are described in detail. Patient groups with microbiology negative and known bacterial etiology had a similar 30-day and 90-day mortality. There were no differences in initial antibiotic treatment regimens, antibiotic treatment duration, rate of intra-pleural fibrinolysis treatment, surgical referral rate, and ICU admittance rate. Patients with microbiology negative etiology were younger (60.8 vs 64.3 years) and fewer had predisposing risk factors (59% vs 71%), but pleural drainage was more often delayed (49% vs 36%). Mortality was similar in patients treated with either of the two nationally recommended initial antibiotic regimens. However, higher 90-day mortality (22.5% vs 9.7%), disease severity (31.5% vs 6.2%), and ICU admittance rate (21.3% vs 2.9%) was observed in a sub-group with initial broad-spectrum treatment compared to patients receiving the nationally recommended initial treatments, irrespective of knowledge of etiology. Several factors correlated independently to 90-day mortality, including age, predisposing risk factors, surgical referral (Odds-Ratios > 1), drainage delay and intra-pleural fibrinolysis (ORs < 1). CONCLUSIONS: No difference was found between patients with microbiology negative and known bacterial etiology regarding outcome or treatment parameters. Treatment factors and predisposing factors independently relating to mortality were found in the cohort. Broad-spectrum antibiotics were initially used for treatment of patients with more severe illness and poorer outcome.
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spelling pubmed-61861312018-10-19 Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors Meyer, Christian Niels Armbruster, Karin Kemp, Michael Thomsen, Trine Rolighed Dessau, Ram Benny BMC Pulm Med Research Article BACKGROUND: We explored the hypothesized importance of early knowledge of microbiological etiology in patients with pleural infection, including comorbidity and treatment factors in the outcome analyses. METHODS: Data from the medical records of a large cohort of 437 consecutive patients in 9 hospitals in East-Denmark were included retrospectively. RESULTS: Microbiology, co-morbidity, therapy and outcome are described in detail. Patient groups with microbiology negative and known bacterial etiology had a similar 30-day and 90-day mortality. There were no differences in initial antibiotic treatment regimens, antibiotic treatment duration, rate of intra-pleural fibrinolysis treatment, surgical referral rate, and ICU admittance rate. Patients with microbiology negative etiology were younger (60.8 vs 64.3 years) and fewer had predisposing risk factors (59% vs 71%), but pleural drainage was more often delayed (49% vs 36%). Mortality was similar in patients treated with either of the two nationally recommended initial antibiotic regimens. However, higher 90-day mortality (22.5% vs 9.7%), disease severity (31.5% vs 6.2%), and ICU admittance rate (21.3% vs 2.9%) was observed in a sub-group with initial broad-spectrum treatment compared to patients receiving the nationally recommended initial treatments, irrespective of knowledge of etiology. Several factors correlated independently to 90-day mortality, including age, predisposing risk factors, surgical referral (Odds-Ratios > 1), drainage delay and intra-pleural fibrinolysis (ORs < 1). CONCLUSIONS: No difference was found between patients with microbiology negative and known bacterial etiology regarding outcome or treatment parameters. Treatment factors and predisposing factors independently relating to mortality were found in the cohort. Broad-spectrum antibiotics were initially used for treatment of patients with more severe illness and poorer outcome. BioMed Central 2018-10-12 /pmc/articles/PMC6186131/ /pubmed/30314475 http://dx.doi.org/10.1186/s12890-018-0726-1 Text en © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Meyer, Christian Niels
Armbruster, Karin
Kemp, Michael
Thomsen, Trine Rolighed
Dessau, Ram Benny
Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
title Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
title_full Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
title_fullStr Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
title_full_unstemmed Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
title_short Pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
title_sort pleural infection: a retrospective study of clinical outcome and the correlation to known etiology, co-morbidity and treatment factors
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186131/
https://www.ncbi.nlm.nih.gov/pubmed/30314475
http://dx.doi.org/10.1186/s12890-018-0726-1
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