|A retrospective analysis of the current management and investigation of pleural infections at the Royal Victoria Hospital Belfast from 1/2/21-31/1/21
|C Eastwood P Nelson M Hunter CA Butler
|Department of respiratory medicine at the Royal Victoria Hospital. Belfast Health and Social care Trust Northern Ireland
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Previous data has suggested around 7.2% of patients admitted to hospital with community acquired pneumonia develop a complicated parapneumonic effusion or empyema.
A retrospective analysis of patients diagnosed with parapneumonic effusion or empyema between 1st February 2020 and 31st January 2021 was performed assessing patient demographics, co-morbidities, microbiology, time-to-drain and outcomes.
Sixteen patients were identified (n=11 males, mean age 57, mean length of stay 25.6 days); 12 were diagnosed as empyema, three as parapneumonic effusion (2 managed conservatively), one chylothorax. Median time to drain was 3 days (range 1-17); 7 patients required more than one drain. Of the 32 total drains, 15 were inserted by Interventional Radiology, 10 by Respiratory and 7 by Thoracics. Nine patients had positive microbiology and antibiotics rationalised accordingly. Nine patients had a pre-existing respiratory co-morbidity. The majority of patients had clinical and radiological resolution; 1 patient was subsequently diagnosed with a mesothelioma.
There is a variance in time to drain in patients with suspected empyema which may influence identification of pathogen and subsequent ability to rationalise antimicrobials. Reliance on the multidisciplinary team is highlighted as is the complexity and prolonged length of stay of these cases with the need for multiple interventions for some patients.