Difference in clinical characteristics and outcomes between hospital-acquired and community-acquired pleural infection

Abstract

Data on the clinical characteristics and outcomes of patients with pleural infection are limited. This retrospective study aimed to describe the clinical characteristics and outcomes associated with community-acquired pleural infection (CAPI) and hospital-acquired pleural infection (HAPI) in a large Chinese tertiary-care hospital in Beijing over 11 years. The study included 832 patients, of whom 84.9% had HAPI. The most common cause of CAPI was pneumonia and pleurisy, whereas the most common cause of HAPI was trauma or chest surgery. The predisposing factors with statistically significant differences between HAPI and CAPI included the presence of an abdominal indwelling catheter (P = 0.012), thoracic cavity drainage (≥ 10 days) (P = 0.003), and use of broad-spectrum antibiotics (P = 0.002). Staphylococcus epidermidis (24.76%) and Streptococcus species (27.00%) were the most common Gram-positive bacteria in HAPI and CAPI, respectively, whereas Acinetobacter baumannii (8.61%) and Escherichia coli (4.38%) were the most common Gram-negative pathogens in HAPI and CAPI, respectively. Virtually any Gram-positive bacteria were resistant to linezolid and vancomycin, except Enterococcus faecium displaying resistance to vancomycin (9.88%). The 30-day mortality after the onset of pleural infection was 13.1%. Multivariable logistic regression analysis suggested that intensive care unit (ICU) admission, solid tumors, chronic renal failure, and a decreased serum albumin level were independent risk factors for pleural infection. No statistically significant difference in mortality was observed between patients with CAPI (11.9%) and those with HAPI (13.3%). Differences were noted in clinical characteristics between HAPI and CAPI. The findings might guide empirical treatments and help improve infection control strategies.

Keywords

clinical characteristics / community-acquired pleural infection / hospital-acquired pleural infection / microbiology / outcome

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