Evolution of empyema thoracis in the last 20 years
MercedesÂ Merino Sanchez,Â InmaculadaÂ Alfageme Michavila,Â NuriaÂ Reyes NÃºÃ±ez
European Respiratory JournalÂ 2016Â 48:Â PA2651;Â DOI:Â 10.1183/13993003.congress-2016.PA2651
Objetive:Â To known the characteristics of complicated paraneumonic pleural effusions (CPE) and pleural empyemas and their evolution in the last 20 years in the Valme hospital area, Seville.
Methods:Â Retrospective and descriptive study, about the cases of CPE and pleural empiema recovered from january of 1985 to december of 2008. For the diagnosis of CPE or empyema we consider three criteria: positive culture, macroscopic purulence of pleural fluid or biochemical criteria of complicated effusion.
Results:Â 417 patients. First analyze the global results. Later we divide in two groups: the first group between 1985 and 1999 (258 patients), and the second group between 2000 and 2008 (159 patients) for comparison. In the second group we observed an increase of mean age (56.5 vs 51.9), female sex (25% vs 13%, p=0.002), mayor CPE (32% vs 22%, p=0.02), extrahospital adcquisition (90% vs 80%, p=0.004) and unknown etiology (19% vs 11%, p=0.02). In the second period were a lower percentage of VIH-AIDS patients (4.4% vs 13.6%), ethilism habit (36.4% vs 63.6%), and none case of tuberculous empyema, but more neoplasms (29% vs 20%, p=0.03) and encapsulated effusions (67% vs 32%, p< 0.0001). The frequency of negative cultures increased in the second period (53.5% vs 38.8%) without differences in the germen distribution. The trend was to use increasingly less caliber drenaje tubes. The thorax surgery derivation (7%) and the mortality rate (11%) remained stable over time.
Conclusions:Â Has been a lot of changes in the clinical profile of patients (age, sex, predisponents factors, morbidity), in the ethiology and in the therapeutic approach, without differences in mortality rate, that remains appreciable.