Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, No. 135 Nanxiao St., 500, Changhua City, Taiwan.
Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua City, Taiwan.
BMC Infect Dis. 2023 Jan 6;23(1):8. doi: 10.1186/s12879-022-07978-z.
Fungal empyema is an uncommon disease and is associated with a high mortality rate. Surgical intervention is suggested in stage II and III empyema. However, there were no studies that reported the outcomes of surgery for fungal empyema.
This study is a retrospective analysis in a single institute. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. We separated the patients into a fungal empyema group and a bacterial empyema group according to culture results. We used 1:3 propensity score matching to reduce selection bias.
There were 1197 empyema patients who received surgery. Of these, 575 patients showed positive culture results and were enrolled. Twenty-eight patients were allocated to the fungal empyema group, and the other 547 patients were placed in the bacterial empyema group. Fungal empyema showed significantly longer intensive care unit stay (16 days vs. 3 days, p = 0.002), longer median ventilator usage duration (20.5 days vs. 3 days, p = 0.002), longer hospital stay duration (40 days vs. 17.5 days, p < 0.001) and a higher 30-day mortality rate (21.4% vs. 5.9%, p < 0.001). Fungal empyema revealed significantly poorer 1-year survival rate than bacterial empyema before matching (p < 0.001) but without significant difference after matching.
The fungal empyema patients had much worse surgical outcomes than the bacterial empyema patients. Advanced age and high Charlson Comorbidity Index score are independent predictors for poor prognosis. Prompt surgical intervention combined with the use of antifungal agents was the treatment choice for fungal empyema.
真菌性脓胸是一种罕见的疾病，死亡率很高。II 期和 III 期脓胸建议进行手术干预。然而，目前尚无研究报道真菌性脓胸的手术治疗结果。
本研究为单中心回顾性分析。纳入 2012 年 1 月至 2021 年 12 月期间接受胸腔镜去皮质术的脓胸患者。根据培养结果将患者分为真菌性脓胸组和细菌性脓胸组。采用 1:3 倾向评分匹配法减少选择偏倚。
共有 1197 例脓胸患者接受手术治疗，其中 575 例培养阳性患者纳入研究。28 例患者被分配到真菌性脓胸组，其余 547 例患者被分到细菌性脓胸组。真菌性脓胸患者的 ICU 入住时间明显延长（16 天比 3 天，p=0.002）、呼吸机使用时间明显延长（20.5 天比 3 天，p=0.002）、住院时间明显延长（40 天比 17.5 天，p<0.001）、30 天死亡率更高（21.4%比 5.9%，p<0.001）。匹配前，真菌性脓胸患者的 1 年生存率明显低于细菌性脓胸患者（p<0.001），但匹配后无显著差异。
真菌性脓胸患者的手术结局明显差于细菌性脓胸患者。高龄和高 Charlson 合并症指数评分是预后不良的独立预测因素。及时的手术干预结合抗真菌药物的使用是真菌性脓胸的治疗选择。
