2005 A clinical review on management of epyema thoracis/complicated parapneumonic effusions in Kwong Wah Hospital
Dr. Wai Chen, Department of Medicine and Geriatrics, Kwong Wah Hospital
Study objectives
To evaluate the treatment outcome of patients with complicated parapneumoic effusion (CPE) and empyema thoracis and to identify factors affecting the clinical response to antibiotics and drainage therapy.
Methods
Retrospective analysis of patient database from January 2001 to December, 2004 with a diagnosis of complicated para-pneumonic effusion or empyema thoracis in Kwong Wah Hospital were performed. Clinical data including age, sex, symptoms, biochemical and microbiological results, findings of chest imaging, drainage procedures, surgical intervention and survival outcome were collected. Comparison was made between the group of patients that was treated successfully with antibiotics plus intercostal pleural drainage versus the group that failed such treatment.
Results
Fifty-eight patients were included in the analysis, with 48 patients (Medical Success group, 82.8%) successfully treated with antibiotics and/or intercostal drainage. The remaning 10 patients (Medical Failure group, 17.2%) did not respond to antibiotics and drainage so either surgery or death was resulted. Initial presentation with cough and sputum (N = 31 [65%] vs. N = 3 [30%], p = 0.044) and adequate ultrasound guided drainage (N = 36 [75%] vs. N = 3 [30%], p = 0.049) were significantly more common in the Medical Success group. Positive pleural fluid culture (N = 20 [42%] vs. N = 9 [90%], p = 0.001) and positive blood culture (N = 6 [13%] vs. N = 4 [40%], p = 0.045) were more commonly found in the Medical Failure group. In Multivariate analysis, positive pleural fluid culture was the only independent negative prognostic factor (p = 0.026) predicting medical treatment failure.
Conclusion
Positive pleural fluid culture was the most important poor prognostic indicator of complicated parapneumonic effusion and empyema thoracis. Early surgical intervention should be considered in this subgroup of patients who failed initial response to antibiotics & drainage therapy.
