Ann Thorac Surg. 2020 Aug 25:S0003-4975(20)31351-5. doi: 10.1016/j.athoracsur.2020.06.056. Online ahead of print.
BACKGROUND: Previous studies of decortication for empyema have demonstrated that patient characteristics are associated with mortality, but the relationship of infectious pathogen to outcome has not been described. Our objective was to analyze the association of microbiology and antibiotic resistance with post-operative mortality following decortication for empyema. We hypothesized that bacterial pathogens, antibiotic resistance and patient characteristics would all contribute to perioperative morbidity and mortality.
METHODS: Patients undergoing pulmonary decortication for empyema from 1/1/2010-10/1/2017 were reviewed retrospectively. Cases were matched to microbiology cultures. The outcomes of interest was a composite of death, tracheostomy, initial ventilator support > 48 hours or unexpected ICU readmission. Antibiotic resistance was categorized as present or absent, and the number of antibiotics with resistance was counted for each patient. We describe the relationship of patient characteristics, antibiotic resistance, and microbiology to mortality.
RESULTS: During the study period, 185 patients underwent decortication, 118 (63.8%) of which had a diagnosis of primary empyema. Positive culture results were present in 79/185 patients (43%). The most common isolate was Streptococcus, present in 29/79 (37%), followed by Staphylococcus in 19/79 (24%). 11/79 patients (13.9%) had fungal infections. 16/79 (20%) patients had polymicrobial empyema. 30/185 (16.2%) patients experienced the composite adverse outcome. In multivariable regression, the composite adverse outcome was associated with emphysema, candida in pleural culture, and antibiotic resistance count.
CONCLUSIONS: Perioperative mortality and morbidity following decortication for empyema is significant. In this cohort, infections with increasing antibiotic resistance are associated with morbidity and mortality among patients with empyema.