Study of clinical profile of empyema thoracis

 

 

Abstract              Background: Empyema thoracis is still a relevant clinical problem in modern medicine practice. It has a complex microbiological profile. Most cases of empyema complicate community- or hospital-acquired pneumonia but a proportion results from iatrogenic causes or develops without pneumonia. Prompt treatment with appropriate systemic antibiotics and chest tube drainage are essential parts of management. In the present study we have attempted to present data on empyema thoracis from our local population. Aim of the study: To identify the risk factors, microbiological profile, various treatment modalities and treatment outcomes in patients with empyema thoracis. Materials and Methods: This was a prospective descriptive observational study conducted in a tertiary care hospital in southern India for a period of 24 months. A total of 82 patients with pus in the pleural cavity were included in the study. The age, gender, symptomatology, risk factors, hematological, biochemical and microbiological parameters were noted. The management, duration of intercostal drainage, antibiotics used and patient outcomes were noted. Results: Of the 82 patients of empyema thoracis, the male to female ratio was 5.3>1. Fever, cough, chest pain, intercostal tenderness was the most common presentation. Sputum culture was productive in 17 patients with E. coli being the most common culprit organism. Pleual fluid cultures were positive in 8 patients. Mean duration of ICD insertion was 14.9 days. Majority of the patients received 2 or more broad spectrum antibiotics and seven patients received ATT. Mortality was seen in 7 patients. Conclusions: Empyema thoracis commonly presents with fever, cough and chest pain. Neutrophilic leucocytosis and elevated ESR are common. Non tubercular empyema is more common than tubercular empyema. Common complications in our series were hepatitis, renal failure and septic shock. Management includes systemic antibiotics for 2-4 weeks and intercostal drainage.

Key Word: Empyema thoracis, Para-pneumonic effusion, Pleural fluid culture, Intercostal drainage