INTRODUCTION :
Pleural infection is a clinical problem with annual incidence of up to 80,000 cases in the western world. Mortality and morbidity is high; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection.
Despite the advent of effective antibiotics, bacterial pneumonia still results in significant morbidity and mortality in the population. In one study of 1,424 patients hospitalized with community-acquired
pneumonia, patients with pleural effusions were 2.7 times more likely to be treatment failures than were those without pleural effusions.
In another study, the relative risk of mortality in patients with community-acquired pneumonia was 7.0 times higher for patients with bilateral pleural effusions and 3.4 times higher for patients with unilateral pleural effusion of moderate or greater size as compared with other patients with community-acquired pneumonia alone.
Most pleural effusions associated with pneumonia resolve without any specific therapy directed toward the pleural fluid, but approximately 10% of patients require operative intervention. Delay in instituting proper therapy for these effusions is responsible for some of the morbidity associated with parapneumonic effusions.
For a simple parapneumonic effusion antibiotics according to
culture and sensitivity will suffice.
In complicated parapneumonic effusion and empyema intervention in the form of thoracentesis, tube thoracostomy, thoracoscopic intervention, surgery will be needed accordingly.
AIM OF THE STUDY :
To describe the bacteriology of pleural space infection and to determine the prognostic factors implied in the outcome of pleural space infection chiefly simple complicated and complex parapneumonic effusion admitted from period of June 2009 to June 2011 in tertiary care respiratory institute (Government hospital of thoracic medicine Tambaram sanatorium) under Stanley medical college Chennai.
It was hypothesized that there could be clinical , laboratory and biochemical prognostic factors determining the outcome of parapneumonic effusion that if identified at the optimal period would result in reduction in morbidity and mortality associated with parapneumonic effusion. This study was aimed at identification of such determinants.
MATERIALS AND METHODS :
The study is prospective analysis of patients cohort admitted to the tertiary care institute from the period of July 2009 to July 2010.
INCLUSION CRITERIA :
1. All patients with parapneumonic effusion admitted to the
institute above age of fifteen years.
2. All patients diagnosed to have simple parapneumonic effusion.
3. All Complicated parapneumonic effusion.
4. All Complex parapneumonic effusion.
EXCLUSION CRITERIA :
1. All patients with effusion of other causes like trauma,
iatrogenic causes,were excluded.
2. Paediatric parapneumonic effusion excluded.
3. Tuberculous pleural effusion excluded.
CONCLUSION :
To conclude determinants such PH, pleural loculation, serum
albumin can predict the outcome of pleural space infection especially in complicated & complex parapneumonic effusion. Such predictors can help to reduce the morbidity and mortality associated with complicated parapneumonic effusion by identification of failing cases and early referral for definite management.
The bacteriology of pleural space infection in our study is
comparable to the bacteriology of similar studies with gram positive and gram negative organisms occurring equally in seventy percentage of infection
