Facteurs pronostics d'échec du traitement médical d'une pleurésie purulente drainée

La prise en charge des pleurésies purulentes n est pas homogène, tant sur la durée de l antibiothérapie, que sur le moyen d évacuation de l épanchement ou sur la durée des fibrinolytiques. Nous avons réalisé une étude rétrospective multicentrique pour rechercher les facteurs prédictifs d échec du traitement médical d une pleurésie purulente évacuée. L objectif secondaire de ce travail était de déterminer les facteurs prédictifs de séquelles radiologiques à 3 mois du traitement médical. Nous avons inclus tous les patients hospitalisés pour prise en charge d une pleurésie purulente dans les services de pneumologie d Amiens, de Saint-Quentin, de Compiègne, et d Abbeville, entre janvier 2000 et décembre 2006. Résultats : 109 patients ont été inclus. Un échec du traitement médical a été mis en évidence dans 29.5% des cas, et 32.1% des patients ont présenté des séquelles radiologiques à 3 mois. Le seul facteur pronostique prédictif de l échec, en analyse multivariée par régression logistique était l absence de kinésithérapie pleurale (p=0.001, OR=3,25, IC [1,29-8,17]). En terme de séquelles radiologiques à 3 mois, la présence d une documentation bactériologique (p=0.031, OR=0.036, IC [0.14; 0.91]) était un facteur associé à un meilleur pronostic. L utilisation de fibrinolytique, le moyen d évacuation de la poche pleurale et une antibiothérapie supérieure à 21 jours n étaient pas des facteurs prédictifs d échec ou de séquelles du traitement médical d une pleurésie purulente. Le point fort de cette étude est l intérêt majeur de la kinésithérapie de longue durée (>3 mois) en terme de séquelles mais surtout d échec. Il serait intéressant pour conforter nos résultats de mettre en place une étude prospective afin d évaluer la durée optimale de la kinésithérapie pleurale ainsi que d une antibiothérapie adaptée.Management of empyema differed between studies. Predictive factors of manangement failure are unknown. We conducted a multicenter retrospective study to determine predictive factors of medical treatment failure in empyema. The secondary objective was to determine predictive factors of sequelae 3 months after medical treatment. We included all patients hospitalized for empyema in a pneumology unit in Amiens, Saint-Quentin, Compiègne, Abbeville, between January, 2000 and December, 2006. Results 109 patients were included. Among them, 29.5 % presented a medical treatment failure in of the cases, and 32.1 % radiological sequelae. After logistic regression, the only one predictive factor of medical treatment failure was the non-use of pleural kinesitherapy (p 3 months), especially to limit management failure. Prospective studies could be interesting to determine the better duration of antibiotics or pleural kinesitherapy.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Actinomyces graevenitzii Pulmonary Abscess Mimicking Tuberculosis in a Healthy Young Man

Pulmonary actinomycosis is a rare disease that is often misdiag-nosed as tuberculosis or lung cancer. Actinomyces graevenitzii is a relatively new recognized Actinomyces species isolated from various clinical samples. The authors report a case of pulmonary actinomycosis caused by A graevenitzii. A computed tomography examination revealed an excavated consolidation in the middle right lobe of a previously healthy young man who presented with a long history of moderate cough. Cultures of the bronchoalveolar lavage fluid confirmed the diagnosis of pulmonary abscess caused by A gravenitzii. At the three-month follow-up consultation and, after six weeks of high-dose amoxicillin, the pulmonary lesion had completely disappeared

Pleural ultrasonography, new standard for para pneumonic effusion? French multicentric prospective study. Preliminary report

European-Respiratory-Society (ERS) International Congress, Milan, ITALY, SEP 09-13, 2017International audienc

CT Imaging Assessment of Response to Treatment in Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma

International audienceBackgroundOne of the major challenges in managing allergic bronchopulmonary aspergillosis (ABPA) remains consistent and reproducible assessment of response to treatment.Research questionWhat are the most relevant changes in computed tomography (CT-scan) parameters over time for assessing response to treatment?Study Design and MethodsIn this ancillary study of a randomized clinical trial (NEBULAMB), asthmatic patients with available CT-scan and without exacerbation during a 4-month ABPA exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT-scan parameters were assessed by systematic analyses of CT-scan findings at initiation (M0) and end of treatment (M4). CT-scans were assessed by two radiologists blinded to the clinical data. Radiological parameters were determined by selecting those showing significant changes over time. Improvement of at least one, without worsening of the others, defined the radiological response. Agreement between radiological changes, clinical and immunologic responses was likewise investigated.ResultsAmong the 139 originally randomized patients, 132 were included. We identified 5 CT-scan parameters showing significant changes at M4: mucoid impaction extent, mucoid impaction density, centrilobular micronodules, consolidation/ground-glass opacities and bronchial wall thickening (P<0.05). These changes were only weakly associated with one another, except for mucoid impaction extent and density. No agreement was observed between clinical or immunologic and radiological responses, assessed as an overall response, or considering each of the parameters (Cohen’s κ, -0.01 to 0.24).InterpretationChanges in extent and density of mucoid impactions, centrilobular micronodules, consolidation/ground-glass opacities and thickening of the bronchial walls were found to be the most relevant CT-scan parameters to assess radiological response to treatment. A clinical, immunologic and radiological multidimensional approach should be adopted to assess outcomes, probably with a composite definition of response to treatment