Liu Chia-Chi, Cheng Ya-Fu, Chen Yi-Ling, Cheng Ching-Yuan, Huang Chang-Lun, Hung Wei-Heng, Wang Bing-Yen
Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan.
Surgery Clinical Research Center, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan.
Gen Thorac Cardiovasc Surg. 2025 Feb 1. doi: 10.1007/s11748-025-02124-3.
Thoracic empyema is a serious infection. Video-assisted thoracoscopic surgery is a recommended treatment, and pleural fluid and tissue cultures are collected intraoperatively. The combination of a pleural peels tissue culture and a pleural fluid culture improves the positive culture rate. We aimed to investigate the role of respiratory secretion cultures to determine the optimal management for improving surgical outcome.
The study analyzed 225 adult patients with phase II/III thoracic empyema who underwent thoracoscopic decortication. Respiratory secretion cultures were obtained and compared with pleural cultures. Key outcomes were culture positivity and pathogen consistency, with secondary outcomes including intensive care unit stay, hospital stay, and mortality.
There were 225 empyema patients with either a positive pleural fluid culture or a positive pleural peel tissue culture. Of these, 76 patients had positive respiratory secretion culture findings during hospitalization. The most common pathogen species were Pseudomonas aeruginosa (44%) and Klebsiella pneumoniae (16%) in the respiratory secretion cultures and Streptococcus spp. (38%) and Klebsiella pneumoniae (12%) in the pleural cultures. There were 30 patients having a common pathogen in the respiratory secretion culture and in the pleural fluid/tissue culture. Poor outcome measures were found in these patients, including the longer use of antibiotics preoperatively [2.50 (1.00-6.00) days versus 5.00 (2.75-11.00) days, p = 0.006] and a higher mortality rate during hospitalization (40.0% versus 17.4%, p = 0.002).
Respiratory secretion cultures are vital for predicting surgical outcomes in bacterial empyema, and prompt specimen collection can improve patient survival.
脓胸是一种严重的感染性疾病。电视辅助胸腔镜手术是推荐的治疗方法，术中会采集胸水和组织培养样本。胸膜剥脱组织培养与胸水培养相结合可提高培养阳性率。我们旨在研究呼吸道分泌物培养在确定改善手术效果的最佳治疗方案中的作用。
本研究分析了225例接受胸腔镜剥脱术的II/III期成人脓胸患者。获取呼吸道分泌物培养结果并与胸膜培养结果进行比较。主要观察指标为培养阳性率和病原体一致性，次要观察指标包括重症监护病房住院时间、住院时间和死亡率。
225例脓胸患者中，胸水培养或胸膜剥脱组织培养呈阳性。其中，76例患者在住院期间呼吸道分泌物培养结果呈阳性。呼吸道分泌物培养中最常见的病原体是铜绿假单胞菌（44%）和肺炎克雷伯菌（16%），胸膜培养中最常见的病原体是链球菌属（38%）和肺炎克雷伯菌（12%）。有30例患者呼吸道分泌物培养与胸水/组织培养中的病原体相同。这些患者的预后指标较差，包括术前抗生素使用时间较长[2.50（1.00 - 6.00）天对5.00（2.75 - 11.00）天，p = 0.006]以及住院期间死亡率较高（40.0%对17.4%，p = 0.002）。
呼吸道分泌物培养对于预测细菌性脓胸的手术效果至关重要，及时采集样本可提高患者生存率。
