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Published ahead of print on July 13, 2006, doi:10.1164/rccm.200601-074OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 7, October 2006, 817-823

A more recent version of this article appeared on October 1, 2006
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Submitted on January 17, 2006
Accepted on July 10, 2006

The Bacteriology of Pleural Infection by Genetic and Standard Methods and its Mortality Significance

Nick A Maskell1, Sarah Batt2, Emma L Hedley3, Christopher W.H. Davies4, Stephen H Gillespie2, and Robert J.O. Davies3*

1 Department of Respiratory Medicine, Southmead Hospital, Bristol, United Kingdom, 2 Department of Microbiology, Royal Free Hospital, London, United Kingdom, 3 Oxford Centre for Respiratory Medicine, Oxford Pleural Unit, Oxford Radcliffe Hospital, Oxford, United Kingdom, 4 Department of Respiratory Medicine, Royal Berkshire Hospital, Reading, United Kingdom

* To whom correspondence should be addressed. E-mail: robert.davies{at}ndm.ox.ac.uk, robert.davies@clinical-medicine.oxford.ac.uk.

Background: Antibiotic choices for pleural infection are uncertain as its bacteriology is poorly described. Methods: Pleural fluid from 434 pleural infections underwent standard culture and a screen for bacteria by amplification and sequencing of bacterial 16S ribosomal RNA gene. Results: 50% of community acquired infections were streptococcal. 20% included anaerobic bacteria. 60% of hospital acquired infections included bacteria frequently resistant to antibiotics (MRSA 25%, Enterobacteriaceae 18%, Pseudomonas spp. 5%, enterococci 12%). Mortality was increased in hospital acquired infection (hospital 17/36, 47%, community 53/304, 17%, relative risk 4.24, 95% C.I. 2.07 to 8.69, p<0.00001, {chi}2, 1 df = 17.47) and in Gram negative 10/22 (45%), S. aureus 15/34 (44%) or mixed aerobic infections 13/28 (46%), compared to streptococcal infection 23/137 (17%) and infection including anaerobic bacteria 10/49 (20%). (p<0.00001, {chi}2 4 df = 23.35). Conclusion: Pleural infection differs bacteriologically from pneumonia and requires different treatment. Antibiotics for community acquired infection should treat aerobic and anaerobic bacteria. Hospital acquired, Gram negative, S. aureus, and mixed aerobic infections have a high mortality.
Key words: Bacteriology; Pleural infection; Parapneumonic effusion; ISRCTN 39138989; Polymerase chain reaction;




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