Original Article

Community-Acquired Thoracic Empyema in Young Adults

Authors: Shinn Jye Liang, MD, Wei Chen, MD, Yu-Chao Lin, MD, Chih-Yen Tu, MD, Hung-Jen Chen, MD, Yu-Lin Tsai, MD, Chuen-Ming Shih, MD, PhD

Abstract

Background: To evaluate the clinical characteristics, bacteriology, and therapeutic outcomes of community-acquired thoracic empyema (CATE) in young adults.


Methods: From December 2000 to December 2005, 428 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were retrospectively reviewed. In total, there were 64 young adult patients who were diagnosed with CATE enrolled in our series, including 56 men (87.5%) and 8 women (12.5%). Ages ranged from 18 to 44 years old (mean = 37).


Results: The most common underlying disease was alcoholism (28%), and the most common isolated microorganism was Viridans streptococci (27.3%). Among the 62 patients who underwent an invasive drainage procedure, 40 (64%) patients who received pigtail tube drainage as their initial treatment yielded a success rate of 70%. Fifteen (24%) patients who received video-assisted thoracoscopic surgery as first-line treatment yielded a success rate of 100%. To evaluate the risk factors for developing septic shock, we found that serum C-reactive protein (CRP) level on the first admission day (22.9 ± 9.1 versus 13.2 ± 8.1 mg/dL), presence of bacteremia (60 versus 13%), occurrence of polymicrobial infection (30 versus 5%) and inadequate antibiotic use (30 versus 7%) had statistical significance (P < 0.05).


Conclusions: Viridans streptococci was the most frequently isolated causative microorganism in young adults with CATE and alcoholism was the most common underlying disease. Moreover, a higher serum CRP level on the first day of admission, occurrence of bacteremia, presence of polymicrobial infection and inadequate antibiotic use were significant risk factors for developing septic shock.


Key Points


* In young adult patients with community-acquired thoracic empyema, the most common underlying disease was alcoholism, and the most common isolated microorganism was Viridans streptococci.


* Young adult patients with community-acquired thoracic empyema who received video-assisted thoracoscopic surgery as first-line treatment had an excellent success rate.


* Higher serum CRP level (>15 mg/dL) on the first day of admission, occurrence of bacteremia, presence of polymicrobial infection and inadequate antibiotic use were significant risk factors for developing septic shock.

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