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. 2024 Dec 11;13(12):1205.
doi: 10.3390/antibiotics13121205.

A 15-Year Observational Cohort of Acute Empyema at a Single-Center in Japan

Nobuhiro Asai  1   2   3 , Wataru Ohashi  4 , Yuichi Shibata  1   2 , Daisuke Sakanashi  1   2 , Hideo Kato  1   5   6 , Mao Hagihara  1   7 , Hiroyuki Suematsu  1   2 , Hiroshige Mikamo  1   2
Affiliations

A 15-Year Observational Cohort of Acute Empyema at a Single-Center in Japan

Nobuhiro Asai et al. Antibiotics (Basel). .

Abstract

Introduction: Despite the advancements in diagnostic methods and antibiotic treatment, empyema is a critical respiratory infection, showing a high mortality rate of 10-25%. Patients and Methods: To evaluate the bacterial etiology and prognostic factors of acute empyema, we conducted this long-term retrospective cohort study at our institute between 2008 and 2022. Results: A total of 80 patients were enrolled in this cohort. The median age was 72 years (range 19 to 93 years), and 61 (76%) were male. The most common underlying disease was malignancy, seen in 28 (35%). The mean Charlson comorbidity index (CCI) was 2.7 (±2.4). The 30-day and in-hospital mortality were 9 (11%) and 15 (19%), respectively. Univariate analysis revealed that healthcare-associated infection, inappropriate treatment, high CCI score, performance status (PS) of 2-4, and isolation of potentially drug-resistant (PDR) pathogens were poor prognostic factors. Finally, multivariate analysis showed that high CCI score (p = 0.009) and isolation of PDR pathogens (p = 0.011) were independent poor prognostic factors for in-hospital death in acute empyema. Conclusions: We found that higher CCI scores and isolation of PDR pathogens were independent poor prognostic factors for in-hospital mortality among empyema patients.

Keywords: dysbiosis; effusion; empyema; pleural infection; potential drug-resistant pathogen.

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Conflict of interest statement

Authors have no conflicts of interests.

Figures

Figure 1
Figure 1
Shows the results of Kaplan–Meier analysis between the two groups. Comparison of overall survival times (OS)s between healthcare-associated and community-acquired empyema (A), between high and low Charlson comorbidity index (B), between appropriate and inappropriate treatment (C), between potential drug-resistant pathogen + and −, (D), between performance status 0–1 and 2–4 (E), between Streptococcus anginosus group (SAG) and non-SAG group (F). Dotted lines show 95% confidence interval.
Figure 2
Figure 2
Shows the comparison of OSs among the four groups; patients with high CCI score plus PDR, those with low CCI score plus PDR, those with high CCI score without PDR, and those with low CCI score without PDR. Dotted lines show 95% confidence interval.
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