Hoth J Jason, Burch Phillip T, Bullock Timothy K, Cheadle William G, Richardson J David
Department of Surgery, University of Louisville School of Medicine, the Trauma Program in Surgery University of Louisville Hospital, and the Veterans Affairs Medical Center, Louisville, Kentucky 40292, USA.
Surg Infect (Larchmt). 2003 Spring;4(1):29-35. doi: 10.1089/109629603764655254.
Thoracic empyema may result either from primary pneumonic sources or intraabdominal sources of infection that seed the pleural space secondarily. In patients with thoracostomy tubes, empyema may result when blood in the pleural space becomes contaminated during tube insertion. To elucidate the cause of posttraumatic empyema, preoperative bronchoalveolar lavage (BAL)/sputum cultures obtained from patients with posttraumatic empyema were compared with cultures obtained at the time of decortication.
A retrospective study was conducted of trauma patients who developed empyema and underwent either video-assisted thoracoscopy or thoracotomy with decortication following blunt or penetrating trauma. At our level I trauma center, we studied all empyema cases diagnosed from November, 1998 to July, 2001. Data collection included patient demographics, injuries sustained, preoperative BAL/sputum cultures, and culture data obtained at the time of decortication. All BAL/sputum cultures were performed no more than 5 days prior to decortication.
Thirty-seven patients (26 blunt/11 penetrating) were identified. No patients had concurrent intra-abdominal sources of infection. All patients had at least one chest tube placed prior to decortication. Preoperative respiratory cultures (BAL/sputum) were obtained in 34 patients. The most common organisms isolated were Staphylococcus aureus in six patients (18%) and Hemophilus influenzae in six patients (18%). Intraoperative cultures were obtained in all 37 patients, with the most common organism being S. aureus isolated in 22 patients (60%). Interestingly, a correlation between preoperative BAL/sputum and intraoperative cultures was found in only seven of the 34 patients (21%) who had concomitant respiratory and pleural cultures. Cultures positive for S. aureus were isolated from five patients, Streptococcus pneumoniae from one patient, and Pseudomonas aeruginosa from one patient.
Little correlation existed between preoperative BAL/sputum cultures and intraoperative cultures in this series of patients with posttraumatic empyema. This suggests that the causation is most often not a parapneumonic process. Furthermore, since S. aureus was the most common organism recovered from empyema, the source was more likely from inoculation of the pleural space by the injury itself or by tube thoracostomy.
胸腔积脓可能源于原发性肺炎病灶或继发于腹腔感染源并累及胸膜腔。对于行胸廓造口术置管的患者，若胸膜腔内血液在置管过程中被污染，可能会导致胸腔积脓。为阐明创伤后胸腔积脓的病因，我们将创伤后胸腔积脓患者术前的支气管肺泡灌洗（BAL）/痰培养结果与胸膜纤维板剥脱术时的培养结果进行了比较。
我们对钝性或穿透性创伤后发生胸腔积脓并接受电视辅助胸腔镜手术或胸膜纤维板剥脱术的创伤患者进行了一项回顾性研究。在我们的一级创伤中心，我们研究了1998年11月至2001年7月期间诊断的所有胸腔积脓病例。数据收集包括患者人口统计学资料、所受损伤、术前BAL/痰培养结果以及胸膜纤维板剥脱术时的培养数据。所有BAL/痰培养均在胸膜纤维板剥脱术前不超过5天进行。
共确定了37例患者（26例钝性伤/11例穿透性伤）。所有患者均无并发腹腔感染源。所有患者在胸膜纤维板剥脱术前均至少放置了一根胸管。34例患者进行了术前呼吸道培养（BAL/痰）。分离出的最常见病原体为6例（18%）金黄色葡萄球菌和6例（18%）流感嗜血杆菌。37例患者均进行了术中培养，最常见的病原体为22例（60%）金黄色葡萄球菌。有趣的是，在34例同时进行呼吸道和胸膜培养的患者中，只有7例（21%）术前BAL/痰培养结果与术中培养结果存在相关性。从5例患者中分离出金黄色葡萄球菌培养阳性，1例患者为肺炎链球菌，1例患者为铜绿假单胞菌。
在这组创伤后胸腔积脓患者中,术前BAL/痰培养结果与术中培养结果之间相关性不大。这表明病因通常并非肺炎旁过程。此外，由于金黄色葡萄球菌是从胸腔积脓中分离出的最常见病原体，其来源更可能是损伤本身或胸腔闭式引流管接种至胸膜腔。
