Thoracic Empyema in HIV-Infected Patients: Bronchopleural fistula
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 hospital stays (36.6±21.2 vs 21.7± 10.4 days; p=0.07) and drainage time (20.5±20.8 vs 7.7±9 days; p=0.09) were more prolonged for these patients.
Clinical and radiologic improvement was observed in nine patients following SK treatment (average dose, 2.3±1.5; range, 1 to 6). The delay time from closed drainage to the use of SK was 4.2±4.9 days (range, 0 to 13 days). Drainage improvement following SK treatment was notable (average, 672 mL before SK vs 1,627 mL after SK), and there was no significant difference in length of hospitalization (25.7± 11.8 vs 25.5± 17.2 days) or drainage time (12.3±10.3 vs 10.2±16 days).
The delay time for arrangement of closed thoracostomy drainage was correlated to hospital stays (r=0.52; 95% confidence interval, 0.14 to 0.77) and drainage time (r=0.55; 95% confidence interval, 0.17 to 0.78). There was no significant difference between loculated and free-flowing pleural fluid, taking into consideration the drainage time and length of hospitalization.
Patients with an AIDS diagnosis needed a longer hospitalization time (p=0.03), and bacteremia was more common (60% vs 46%; p=NS). Nevertheless, the presence of thrombophlebitis-endocarditis, polymicrobial empyemas (30% vs 54%; p = NS), and patients with multiple-isolated organisms was less frequent (considering all samples). Other characteristics are summarized in Table 3 and we did not find differences between the groups, except in lymphocytes and CD4 counts. buy zyrtec online
During hospitalization, we found 11 complications in 9 patients (39%): 5 were due to chest tubes (1 due to an obstruction and a residual empyema, 1 because of a relapse after withdrawal, 1 due to a splenic laceration, 1 because of a reversible obstruction, and lastly, a residual pneumothorax). The remainder were infectious (two bilateral empyemas, one persistent BP, one peritoneal septic embolization, and one infected central venous catheter), with the exception of the last case, which was a fever due to antibiotics.
Table 3—Characteristics of Hospitalization and Laboratory Tests in Patients With and Without AIDS Diagnosis
|Drainage||18 (78%)||7 (70%)||11 (85%)||NS|
|Drainage time||14.1±14.1||14.2± 15.2||14±14.2||NS|
|Days of fever||5.6±4.8||5.8±4.9||5.4±4.9||NS|
|Complications||9 (39%)||4 (40%)||5 (38%)||NS|
|Endocarditis||5 (22%)||2 (20%)||3 (23%)||NS|
|Thromboph. *||6 (26%)||2 (20%)||4 (31%)||NS|
|> 1 bacteria in pleural fluid||10 (43%)||3 (30%)||7 (54%)||NS|
|Bacteremia||12 (52%)||6 (60%)||6 (46%)||NS|
|>1 bacteria in all samples||13 (57%)||4 (40%)||9 (69%)||NS|
|Leukocytes, cells/mm||7,420±4,725||6,698 ±4,929||7,976±4,685||0.07|
|Lymphocytes, cells/mm||1,458 ±656||1,171±323||1,678±768||0.005|
|CD4 counts, cells/mm||366±217||171±118||517±139||0.005|