Sanaullah Tareen, Muhammad Yaseen, Zafar Iqbal, Aria Masoom.
Analysis of 42 consecutive cases of empyema thoracis.
APIMS Jan ;6(4):205-9.

Abstract: The etiology of empyema thoracis depends on the geographic region, patient age, and advances in the diagnosis of the underlying cause. It continues to cause significant morbidity and mortality despite the improvement of antimicrobial therapy and the existence of multiple options for drainage. Rapid evaluation, early non-surgical therapies to promote pus drainage reduces morbidity, mortality and health care cost in the management. Objectives: To investigate the characteristics of bacterial isolates and evaluate chest tube drainage in the early management of empyema thoracis. Study Design: Hospital based cross-sectional analytic type study. Setting: The study was conducted at the department of Pulmonology, Pakistan Institute of Medical Sciences, Islamabad. Duration of study: Eight months study started from August 1st 2006 to 30th March 2007. Subjects and Methods: A total of 42 patients- 34 (81 %) male and 8 (19%) female-who fulfilled the diagnostic criteria of Empyema thoracis, were included in the study. Aspirated empyema fluid was subjected to routine culture as well as to AFB culture. Direct microscopic examination of Gram and ZIiehl-Neelson stained smears was also carried out. All patients underwent closed chest-tube drainage after obtaining a written informed consent. Total days of hospital stay, referral and outcome of surgical intervention were recorded. Results: 42 cases (culture positive = 11, culture negative = 31) of empyema were identified. Men were predominant (34 men Vs 8 women). The mean age was 43 years (95 % C.I, 37.74- 49.44). Only 11 (26%) yielded bacterial growth on culture which were gram negative enteric rods except S. pyogenes being the only other organism isolated from two samples No sample was found to be positive for Mycobacterium tuberculosis. Closed chest tube drainage was successful in 85.7 %. Surgical procedures were required in 14.3 %. Average hospital stay with chest tube was 14 days and mortality rate was 7%. It was incidentally found that 28 (66.7%) subjects were diabetics, 5 (11.9%) were HCV positive and 7 (16.70%) were in renal failure. Conclusion: In most cases causative microbes were Gram’s Negative Bacilli and lower yield on culture was probably due to prior use of antibiotics and ATT and underlying immune compromised state. Conservative management with chest tube drainage was simpler and adequate in most cases. Average hospital stay with chest tube was 14 days with mortality rate of 7%. The immediate and long term outcome with chest tube drainage was satisfactory in most of the cases of non-loculated empyema however additional surgical procedures were needed in 17% cases.

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