AJM Theme Issue: Pulmonology/AllergyClinical research studyThoracic Empyema in Patients with Community-Acquired Pneumonia
Section snippets
Subjects
All patients admitted to a hospital within the Capital Health region (Edmonton, Canada) with a clinical diagnosis of CAP between November 15, 2000, and November 14, 2002, were included in the study population. Capital Health region is an integrated health system that serves a population of approximately 1 million people and is composed of 2 tertiary care hospitals, 2 hospitals that provide secondary and some tertiary care, 2 community hospitals, and 1 freestanding emergency department. This
Results
Over a 2-year period, 3675 patients were admitted to Capital Health region with suspected CAP. Of these, 47 (1.3%) patients were given a diagnosis of empyema by the attending physician. After our definition of empyema was applied to this subgroup, 24 (0.7%) were definite cases, and 23 (0.6%) were classified as suspected cases of empyema (Figure 1).
Discussion
The true incidence of thoracic empyema complicating CAP has not been well defined and was previously noted to be 1.6%10 In our study, 1.3% of patients admitted to a hospital with a clinical diagnosis of CAP were diagnosed with empyema by the attending physician. Of these, only half (24/47 patients) actually met conventional microbiologic, pleural fluid, or radiologic criteria for the diagnosis, giving a true incidence of 0.7%. The remaining patients had complicated pleural effusion and not true
Conclusion
This study shows several important updated features of empyema caused by CAP. First, empyema seems to be an uncommon complication of CAP with an incidence of 0.7%. Clinical and laboratory features remain nonspecific and should be used with caution when differentiating among empyema, complicated parapneumonic effusion, and CAP. This study is also consistent with the trend of S. milleri group as an emerging pathogen in the pathogenesis of empyema. Finally, in-hospital mortality seems to be
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2020, ChestCitation Excerpt :US imaging and US-guided aspiration led to a confirmed diagnosis of empyema. Empyema is defined as an exudative effusion within the pleural space associated with pleural inflammation, followed by polymorphonuclear leukocytes and fibrin deposition with pus accumulation.1,2 Visualizing an empyema on US typically shows a collection of pus with a uniform and speckled appearance.3