Chen Wei, Lin Yu-Chao, Liang Shinn-Jye, Tu Chih-Yen, Chen Hung-Jen, Hang Liang-Wen, Hsu Wu-Huei, Shih Chuen-Ming
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
South Med J. 2009 Sep;102(9):909-14. doi: 10.1097/SMJ.0b013e3181b22c52.
The objective of this study was to assess the etiology, microbiology and outcome of hospital-acquired thoracic empyema (HATE) in adults.
From December 2001 to December 2006, 459 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were screened for HATE. HATE was defined as a new pleural empyema which developed after 48 hours of hospitalization.
In total, 56 adult (>or=18 years) patients who were diagnosed with HATE were enrolled in our series, including 35 men (62.5%) and 21 women (37.5%), with ages ranging from 22 to 87 years old (mean = 59). Causes of HATE were classified into two categories: hospital-acquired pneumonia (HAP) related (n = 25) and non-HAP related (n = 31). Causes of non-HAP related empyema were comprised of catheter-related infections (n = 20), hepatobiliary tract infections (n = 6), septic emboli (n = 4), and postpneumonectomy (n = 1). Comparing the bacteriology between the two categories, HAP-related empyema had a significantly higher incidence of aerobic Gram-negative organisms (76% vs. 38.7%, P = 0.005), polymicrobial pathogens (40% vs. 9.7%, P = 0.008), and anaerobic pathogens (20% vs. 0%, P = 0.009) than non-HAP related empyema. However, there was no significant difference in mortality rate (60% vs. 52%, P = 0.52) between the two categories.
Choice of antibiotic treatment for HATE should be based on the etiology of the pleural infection. In treating HAP-related empyema, antibiotics should cover aerobic Gram-negative, polymicrobial, and anaerobic pathogens.
本研究的目的是评估成人医院获得性胸腔积液（HATE）的病因、微生物学及预后。
2001年12月至2006年12月，在一家三级医院对459例诊断为胸腔积液的成年患者进行HATE筛查。HATE定义为住院48小时后出现的新发胸膜腔积液。
本研究共纳入56例诊断为HATE的成年（≥18岁）患者，其中男性35例（62.5%），女性21例（37.5%），年龄范围为22至87岁（平均59岁）。HATE的病因分为两类：与医院获得性肺炎（HAP）相关（n = 25）和与非HAP相关（n = 31）。非HAP相关胸腔积液的病因包括导管相关感染（n = 20）、肝胆管感染（n = 6）、脓毒性栓子（n = 4）和肺叶切除术后（n = 1）。比较两类患者的细菌学情况，与HAP相关的胸腔积液中需氧革兰氏阴性菌（76% 对38.7%，P = 0.005）、多种微生物病原体（40% 对9.7%，P = 0.008）和厌氧病原体（20% 对0%，P = 0.009）的发生率显著高于非HAP相关胸腔积液。然而，两类患者的死亡率无显著差异（60% 对52%，P = 0.52）。
HATE的抗生素治疗选择应基于胸膜感染的病因。在治疗与HAP相关的胸腔积液时，抗生素应覆盖需氧革兰氏阴性菌、多种微生物和厌氧病原体。
