The Impacts of Initial Therapy on Clinical Outcome of Patients with Thoracic Bacterial Infection_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

JiangHongni ¹ , TangMin ² , LiuJie ¹ ,  QuJieming ³

1. Department of Respiratory Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China;
2. ;
3. ;

Corresponding author：

QuJieming, Email: jmqu0906@163.com

Keywords：

Thoracic bacterial infection; Antibiotics; Pleural drainage

DOI：

10.7507/1671-6205.2016127

Video：

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Objective To observe the impacts of initial therapy on clinical outcome of patients with community-acquired thoracic infection by retrospective analysis. Methods Clinical data of acute community-acquired thoracic infection patients who met the British Thoracic Society diagnostic criteria were collected. The patients were divided into two groups according to whether adequate initial antibiotic therapy and pleural effusion drainage were performed, namely an adequate group (31 patients) and an inadequate group (17 patients). Clinical manifestations, inflammatory markers, hospital stay and hospital costs were analyzed between the two groups. Results For age, gender, infection sites, and coincident diseases, there were no significant differences between the two groups. Compared with the inadequate group, temperature of the adequate group was significantly decreased, especially on hospital day 5, 6, 7[(37.4±0.1)℃ vs. (38.3±0.2)℃, P < 0.001; (37.4±0.1)℃ vs. (37.9±0.1)℃, P < 0.05; (37.4±0.1)℃ vs. (38.1±0.2)℃, P < 0.01]. The level of serum C-reactive protein (CRP) in first week was also significantly reduced in the adequate group[(123.1±13.8) mg/L vs. (182.7±25.3) mg/L, P < 0.05]. However, there were no differences in white cell counts, percentage of neutrophils, or erythrocyte sedimentation rate between the two groups in six-week follow-up. The adequate group had shorter hospital stay[(25±4) days vs. (34±4) days, P < 0.05] and lower hospital costs[(28 367±3 328) yuan vs. (43 334±7 134) yuan, P < 0.05] compared with the inadequate group. Conclusions The initial therapy with appropriate antibiotics and effective thoracic drainage can significantly decrease the temperature and CRP of patients with thoracic infection, as well as the cost of hospitalization and the length of stay. Our study reveals that the temperature which is lower than 37.5℃ on the 5th day of therapy and the CRP in the first follow-up week are sensitive predictors of initial treatment effect, which may be helpful to guide the following therapeutic strategies.

Citation： JiangHongni, TangMin, LiuJie, QuJieming. The Impacts of Initial Therapy on Clinical Outcome of Patients with Thoracic Bacterial Infection. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(6): 552-556. doi: 10.7507/1671-6205.2016127 Copy

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1. Finley C, Clifton J, Fitzgerald JM, et al. Empyema:an increasing concern in Canada. Can Respir J, 2008, 15:85-89.
2. Farjah F, Symons RG, Krishnadasan B, et al. Management of pleural space infections:a population-based analysis. J Thorac Cardiovasc Surg, 2007, 133:3463-3451.
3. Ahmed AE, Yacoub TE. Empyema thoracis. Clin Med Insights Circ Respir Pulm Med, 2010, 4:1-8.
4. Maskell NA, Davies CW, Nunn AJ, et al; First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med, 2005, 352:865-874.
5. Davies HE, Davies RJ, Davies CW; BTS Pleural Disease Guideline Group. Management of pleural infection in adults:British Thoracic Society Pleural Disease Guideline 2010. Thorax, 2010, 65(Suppl 2):ii41-53.
6. Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med, 2006, 174:817-823.
7. Tokuda Y, Matsushima D, Stein GH, et al. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions:a meta-analysis. Chest, 2006, 129:783-790.
8. Nie W, Liu Y, Ye J, et al. Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion:a meta-analysis of randomized control trials. Clin Respir J, 2014, 8:281-291.
9. St Peter SD, Tsao K, Spilde TL, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children:a prospective, randomized trial. J Pediatr Surg, 2009, 44:106-111.
10. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med, 2006, 174:221-227.
11. McCauley L, Dean N. Pneumonia and empyema:causal, casual or unknown. J Thorac Dis, 2015, 7:992-998.

Chinese Journal of Respiratory and Critical Care Medicine

The Impacts of Initial Therapy on Clinical Outcome of Patients with Thoracic Bacterial Infection

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