Miyazaki T, Mori T
Division of Infectious Diseases, Department of Internal Medicine, Juntendo University School of Medicine.
Kansenshogaku Zasshi. 1991 Dec;65(12):1583-92. doi: 10.11150/kansenshogakuzasshi1970.65.1583.
Ninety-eight cases of empyema thoracis admitted to Juntendo University Hospital between 1979 and 1990 were reviewed. Males accounted for 78 cases and females 20 cases. Thirteen pediatric patients ranged in age from 17 days to 4 years, while the 85 adult cases ranged from 16 to 89 years (mean: 58.4 years). The mortality rate increased with age. Fifty-three cases of community-acquired empyema thoracis consisted of 24 with no underlying disease (including 13 pediatric cases), and 29 with diabetes mellitus, alcoholic liver damage or chronic obstructive bronchopulmonary disease. Forty-five nosocomial empyema cases occurred after chest operation or thoracocentesis, or due to a subdiaphragmatic pathogenic condition or congestive heart failure complicated with aspiration pneumonia. In this series, 63 patients (64.3%) had para- or post-pneumonic empyema. Compared with the community-acquired infection cases, the mortality rate of the nosocomial infection cases was very high. Seventy-eight cases were culture-positive, including 3 positive for Mycobacterium tuberculosis. The remaining 20 cases were culture-negative. In 75 cases of culture-positive pleural fluid, aerobic bacteria were isolated from 31 cases (mortality rate: 22.6%), anaerobes mixed with aerobes from 21 cases (mortality rate: 52.4%), and anaerobes only from 23 cases (mortality rate: 21.7%). Thus, the mortality rate of mixed infected cases was highest. Anaerobes were frequently isolated from the community-acquired empyema cases, and were often found in para- or postpneumonic lesions, including aspiration pneumonia. The most commonly encountered aerobe was Staphylococcus aureus. Among the anaerobes, Bacteroides spp., microaerophilic streptococcus, Peptostreptococcus and Fusobacterium spp. were most common. A single organism was isolated in pure culture from 39 cases. Single organisms isolated from fluids were more frequently aerobes (25) than anaerobes (14). The cases harboring Bacteroides spp. showed the worst outcome, with 11 deaths in 25 such cases.
回顾了1979年至1990年间收治于顺天堂大学医院的98例脓胸病例。男性78例，女性20例。13例儿科患者年龄从17天至4岁不等，而85例成年病例年龄从16岁至89岁（平均：58.4岁）。死亡率随年龄增长而增加。53例社区获得性脓胸病例中，24例无基础疾病（包括13例儿科病例），29例患有糖尿病、酒精性肝损害或慢性阻塞性肺疾病。45例医院获得性脓胸病例发生于胸部手术或胸腔穿刺后，或由于膈下致病情况或充血性心力衰竭合并吸入性肺炎。在本系列中，63例患者（64.3%）患有肺炎旁或肺炎后脓胸。与社区获得性感染病例相比，医院获得性感染病例的死亡率非常高。78例培养阳性，其中3例结核分枝杆菌阳性。其余20例培养阴性。在75例培养阳性的胸腔积液病例中，31例分离出需氧菌（死亡率：22.6%），21例分离出厌氧菌与需氧菌混合菌（死亡率：52.4%），23例仅分离出厌氧菌（死亡率：21.7%）。因此，混合感染病例的死亡率最高。厌氧菌常从社区获得性脓胸病例中分离出，且常见于肺炎旁或肺炎后病变，包括吸入性肺炎。最常见的需氧菌是金黄色葡萄球菌。在厌氧菌中，拟杆菌属、微需氧链球菌、消化链球菌和梭杆菌属最为常见。39例病例通过纯培养分离出单一微生物。从胸腔积液中分离出的单一微生物中，需氧菌（25例）比厌氧菌（14例）更常见。携带拟杆菌属的病例预后最差，25例此类病例中有11例死亡。
