University College London Hospitals NHS Foundation Trust.
Cleveland Clinic London, London, UK.
Curr Opin Pulm Med. 2024 May 1;30(3):204-209. doi: 10.1097/MCP.0000000000001054. Epub 2024 Feb 7.
The aim of this study was to review current key points in the aetiology, diagnosis, treatment, and prevention of empyema thoracis. Early postpandemic trends have seen an increasing global incidence and evolution in the aetiology of empyema. Due to varied aetiology and typically lengthy treatment, empyema will be disproportionately affected by the rising tide of antimicrobial resistance (AMR), thus warranting attention and further research.
Multiple novel biomarkers (e.g. IL-36γ) are under investigation to aid diagnosis, while oral health assessment tools are now available for prognosticating and risk-stratifying patients with thoracic empyema. There exists an ongoing lack of evidence-based guidance surrounding antibiotic treatment duration, surgical intervention indication, and prognostic scoring utility.
Understanding aetiologies in different global regions and settings is pivotal for guiding empirical treatment. Antimicrobial resistance will make thoracic empyema increasingly challenging to treat and should prompt increased awareness of prescribing practices. Novel biomarkers are under investigation which may speed up differentiation of pleural effusion types, allowing faster cohorting of patients.Although newly identified predictors of morbidity and mortality have been suggested to be beneficial for incorporation into clinical practice, further work is required to prognosticate, risk-stratify, and standardize treatment.
本研究旨在综述脓胸的病因、诊断、治疗和预防方面的最新要点。大流行后早期，脓胸的全球发病率和病因学呈上升趋势。由于病因多样，且治疗时间通常较长，脓胸将受到日益严重的抗生素耐药（AMR）的不成比例影响，因此值得关注和进一步研究。
目前正在研究多种新型生物标志物（如 IL-36γ）以辅助诊断，而口腔健康评估工具现已可用于预测和分层患有胸脓胸的患者的风险。在抗生素治疗持续时间、手术干预指征和预后评分实用性方面，目前仍缺乏循证指导。
了解不同全球区域和环境中的病因对于指导经验性治疗至关重要。抗生素耐药性将使脓胸的治疗变得更加困难，应促使人们提高对抗生素使用的认识。目前正在研究新型生物标志物，这些标志物可能有助于加快胸腔积液类型的区分，从而更快地对患者进行分组。尽管已经提出了一些新的发病率和死亡率预测因素，以便将其纳入临床实践，但仍需要进一步研究以进行预后、风险分层和标准化治疗。
