Our findings suggest that ampicillin and cloxacillin would be an inappropriate empiric therapy, if given in a nonselective fashion to these patients, since nearly 16% of isolated organisms were resistant to these drugs. The resistant organisms that we identified are commonly associated with nosocomial infections. This could explain the substantial proportion of more resistant organisms, […]

As in other series, polymicrobial and BP-associated empyemas required longer periods of hospitalization and pleural drainage. Moreover, the presence of endocarditis-thrombophlebitis and bacteremia was more common. The delay in arranging closed drainage was correlated to a longer period of hospitalization and a longer drainage time. However, there was no significant difference between loculated and nonloculated […]

The finding of S pneumoniae has been described in from 2% to 21% of cases in other series of empyema. In our series, it was found within the expected range (9%). Among Gram-negative bacilli, H influenzae was isolated in only 3% of our patients, whereas Pseudomona species was more frequent (9%). The percentage of sterile […]

Ambrosi et al report 16 empyemas and the outcomes were successful in all cases with percutaneous drainage (CT guided). Mouroux et al, in a study of chest surgical management of thoracic manifestations in HIV-infected patients, described 18 empyemas. Nine cases were treated by drainage, with the remaining nine requiring decortication; one death was recorded. Only […]

The antimicrobial agents administered are listed in Table 4. Based on microbiological findings, antibiotics were changed in 83% (19/23) of the cases (by a more sensitive or less toxic agent). Pathogens resistant to ampicillin were isolated in 8 of 61 cases (13%). These included two S pneumoniae, three Haemophilus species, one Streptococcus intermedins, one Streptococcus […]

Six patients had bronchopleural fistula (BP) and none required surgery. This was more common in patients with an AIDS diagnosis (40% vs 15%), endocarditis or thrombophlebitis (60% vs 17%; p = 0.08), bacteremia (83% vs 40%; p = NS), and those with polymicrobial flora in the pleural fluid (67% vs 35%; p = NS). Both […]

Gram’s stains from pleural fluid samples were negative in 12 cases (52%); however, organisms were later cultured from 8 of these cases. Of the 19 positive cultures, 13 (68%) had exclusively aerobic bacteria, 2 (11%) had exclusively anaerobic bacteria, and 4 (21%) had both aerobic and anaerobic bacteria. All the isolated organisms are listed in […]

Antibiotic therapy and cavity drainage with closed thoracostomy commenced immediately. Success was measured by clinical and radiologic (or CT) status improvement within a 24- to 48-hr period. Drainage was maintained until the daily fluid yield dropped to <50 mL and improvement in the chest radiograph was evident. Indication for intrapleural thrombolytics (streptokinase [SK]) was persistent […]

We reviewed computerized medical records of HIV-infected patients admitted to Valme University Hospital between January 1985 and November 1993. Of the 419 patients identified as HIV positive, 23 (5.4%) had a hospital discharge diagnosis of thoracic empyema and all were available for review. The diagnosis was confirmed by one of following criteria: pleural fluid culture […]

Microbiology, Management, and Outcome Thoracic empyema seems rare in adult HIV-related diseases, despite the increased incidence of respiratory infections, although there are no available data (to our knowledge) to estimate true incidence. In the general population, empyema is most common as a consequence of community-acquired pneumonia. Bacterial pneumonia is common in patients with AIDS, but […]