Optimal Duration of Antibiotics Therapy After Video-assisted Thoracoscopic Surgery in Thoracic Empyema and Complicated Parapneumonic Effusion

BackgroundThere is no evidential report about the optimal duration of antibiotic use following video-assisted thoracoscopic surgery debridement (VATS-D) in thoracic empyema (TE) or complicated parapneumonic effusion (PPE). The purpose of this study was to determine the optimal duration of antibiotic therapy after VATS-D for TE /PPE.MethodsBetween January 2011 and December 2019, total thirty-three patients (28 men, 5 women; median age 63 years) corresponding to ACCP category 3 or 4 receiving VATS-D were included in the study. Time until the body temperature (BT) was to be less than 37.5 ºC and 37.0 ºC, WBC count to be less than 10,000/μl and segmented neutrophil (seg) count to be less than 80% were retrospectively analyzed.ResultsThe median time from the onset of TE/PPE to the operation was 13 days. Pre and postoperative antibiotic had median values of 5 and 7 days, respectively. There were no hospital deaths within 30 days of the operation. Major complications occurred in 4 cases (3 respiratory failures and one celebral infarction). Median postoperative hospital stay was 14 days. Success rate in TE/PPE treatment was 88%. The median number of days until the conditions met were BT>37.5 ºC for 3 days, BT>37.0 ºC for 6 days, WBC<10,000 for 4 days and seg<80% for 7 days.ConclusionThe optimal antibiotic duration of antibiotic use after VATS-D for TE/PPE is approximately 5 days. Urgent VATS-D will shorten the total antibiotic duration.

Thoracic empyema: clinical course and management in Trivandrum Medical College

Background: The incidence of empyema thoracis among adults is increasing steadily. It may be primary empyema (pleural infection developing without pneumonia) or secondary empyema. The common cause of secondary empyema being- community acquired pneumonia or hospital acquired pneumonia, empyema due to iatrogenic causes, secondary to trauma etc. With advancement in science and technology, early recognition of empyema in patients with symptoms is now possible. But the treatment guidelines are not unified so that each physician may treat this condition in a different way without referring to higher concerned specialties making it complicated. The objective of this study was to determine the clinical profile of thoracic empyema in Trivandrum Medical College a tertiary care centre in South Kerala.Methods: A total of 56 patients with empyema admitted to Government Medical College, Trivandrum, Kerala in 2018-2019 were reviewed retrospectively. The demographic details, clinical presentation, etiology, microbiological findings, and management were recorded in a planned proforma, and analysis was done.Results: The mean age was 49.1 years with peak incidence seen in 40-60 years of age. The male to female ratio was 4.6:1.0 and right pleura was more involved than left pleura. Risk factors were diabetes mellitus, chronic obstructive pulmonary disease, pulmonary tuberculosis, and smoking. Etiology of thoracic empyema was infective in 78.6% cases and traumatic in 21.4% cases. Only two cultures showed gram positive aerobe, rest of the culture was sterile. Only a few cases resolved with medical management. Decortication was needed for 52 patients (82.1%).Conclusions: A unified protocol need to be formulated and followed up in all centres for the management of empyema before its evolution and thus reducing the incidence of empyema and its associated complications.

Frequency of Bacteriological Organism in Patients with Thoracic Empyema

Objective: To examine the frequency of bacteriological organism present in pleural fluid, in patients positive with thoracic empyema, assessed on the basis of pus culture test. Study Design: Cross-sectional study Place and Duration: Inpatient Department, Chest Medicine Ward 12, JPMC, Karachi, Pakistan for six months duration from 11 February 2019 to 10 August 2019. Methodology: One hundred and thirty nine patients diagnosed with Thoracic Empyema were included in this study. All patients included in the study shall undergo Pus Culture Test prior to identify the presence or absence of bacterial organism. Those with positive bacterial findings (mainly Staph Aureus and gram negative organisms) were further assessed for stratification with reference to their possible variable affecters. Results: There were 107 males and 32 females (%M: F ratio 77:23), with Empyema Thoracic, aged between 25-55 years and having a mean age of 36.28 year (± SD 8.206), were studied. The Pus Culture Test rate was 100% whereas duration of empyema was of average 18.38 days (± S.D 11.16). One hundred and four patients (74.82%) were carrying investigated bacteria which were staph. Aureus in 17 (12.50%) patients. GRAM NEGATIVE ORGANISMS in 87 (62.58%) patients. Echerea Coli in 12 (8.3%) patients, Pseudomonas. Aeruginosa in 46 (33.33%) patients, Klebseilla in 17(12.50%) patients, Enterococcus Species in 12 (8.3%) patients. While remaining thirty five patients (25.17%) were found to have other bacteria, including Streptococcus, Proteus Mirabillis and Acinobacter, responsible for Empyema. Conclusion: It is concluded that 74.82% patients had bacteria and among them 62.58% patients had gram negative organism. Pseudomonas Aeruginosa was the most common organism followed by Klebseilla and staph. Aureus. Keywords: Empyema, Thoracic, Pleural Effusion, Thoracentesis, Thoracostomy