Thoracic Empyema in HIV-Infected Patients: Materials and Methods
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 or Gram’s stain showing organisms; documentation of gross purulent fluid at thoracentesis; or biochemical evidence of empyema defined as pH <7.10 and either lactate dehydrogenase level >1,000 IU/L or glucose level <40 mg/dL.
Charts were reviewed for patient age, sex, known risk factors for HIV infection, and symptoms. We obtained the following information about the HIV disease stage at the time of diagnosis of empyema: years from HIV infection diagnosis; presence of AIDS diagnosis; and blood tests, including CD4 counts, within a period of 3 months prior to or following the hospital admission date.
Chest radiographs and CT studies were reviewed. The site and extent of pleural involvement and the presence of parenchymal disease and cavity formation were noted. We also investigated as to whether the pleural fluid was loculated or free. The bacterio-logic diagnosis, by microbiological examination of pleural fluid and other samples, was recovered, paying special attention to antimicrobial sensitivity studies. Bacteremia was defined as the isolation of a bacterial pathogen from two or more blood culture samples. Endocarditis required either a demonstration of valvular vegetations on echocardiography or evidence of septic emboli. canadian neighbor pharmacy
The following data about the timing of procedures were noted: days prior to hospital admission from the outset of symptoms; days from hospital admission to chest tube drainage, days of drainage, use of fibrinolytic agents, and volume of pleural fluid drained; and success of each procedure, length of hospitalization, complications, and outcome.