The microflora of patients with acute parapneumonic pleural empyema and optimization of empiric antibiotic therapy
Background. Pleural empyema, like any purulent disease, requires antibiotic therapy and determining the sensitivity of bacteria to antibiotics. However, the microflora and the antibiotic resistance of bacteria are constantly changing. So, it is important to study the spectrum and properties of causative agents. The purpose was to study the microbiological characteristics of patients with acute pleural empyema and to develop recommendations for optimizing empiric antibiotic therapy. Materials and methods. A comprehensive retrospective study was performed of 124 cases of acute nonspecific parapneumonic pleural empyema. There were 92 (74.2 %) male patients. The median age of the patients was 50.3 (38; 61) years. Results. A positive result was obtained in 34 (27.4 %) cases when analyzing pleural effusion. It should be noted that the majority of patients — 101 (81.5 %) previously received antibiotic therapy. Thus, among patients who had not previously received treatment, this index was significantly higher — 12 (52.2 %) vs 22 (21.8 %), p < 0.01. Gram-negative and Gram-positive bacteria were equally common: 19 (51.4 %) and 18 (48.6 %) isolates, respectively. There were 5 main pathogens: Ps.aeruginosa, St.epidermidis, St.aureus, Str.pneumoniae, Str.mitis, which accounted for 59.4 % of isolates. Conclusions. Cultural studies in pleural empyema are characterized by a significant number of negative results (72.6 %). Based on the sensitivity of the main pathogens to antibiotics, the recommended empiric first-line antibacterial therapy should consist of a combination of imidazole derivatives (metronidazole, ornidazole) and cefoperazone with sulbactam. As a second-line preparation, it is advisable to use gatifloxacin, and as reserve antibiotic — gentamicin or tobramycin.
Full Text:PDF (Українська)
BhatnagarR, MaskellNA. TreatmentofComplicatedPleuralEffusionsin 2013.Clin Chest Med. 2013;34(1):47-62. doi: 10.1016/j.ccm.2012.11.004.
Koma Y, Inoue S, Oda Net al. Clinical Characteristics and Outcomes of Patients with Community-acquired, Health Care-associated, and Hospital-acquired Empyema. Clin Respir J. 2017 Nov;11(6):781-788. doi: 10.1111/crj.12416.
Jain SN, Banavaliker J. Empyema Thoracis: Bacteriological Analysis of Pleural Fluid from the Largest Chest Hospital in Delhi. J Empyema Thoracis. 2013;3(6):46-51.doi: 10.9790/0853-0364651.
Scarci M, Abah U, Solli P et. al. EACTS Expert Consensus Statement for Surgical Management of Pleural Empyema. Eur J Cardiothorac Surg. 2015 Nov;48(5):642-53. doi: 10.1093/ejcts/ezv272.
Rahman NM, Maskell NA, West A et al. Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection. N Engl J Med. 2011;365(6):518-26. doi: 10.1056/NEJMoa1012740.
Chubar IV. Analiz mikroflory plevralnoi porozhnyny pry empiiemi plevry. Klinichna khirurhiia. 2016;4:47 – 49.
Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH, Davies RJ. The Bacteriology of Pleural Infection by Genetic and Standard Methods and Its Mortality Significance. Am J Respir Crit Care Med. 2006;174(7):817-23. doi: 10.1164/rccm.200601-074OC.
Copyright (c) 2018 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2018