Stern JB, et al. - Microbiology and its impact on management and prognosis in post-pneumonectomy empyema (PPE) was the prime focus of this investigation. An early occurrence of PPE, mostly with polymicrobial cultures, including Gram-negative bacterias, was found to be related to a high mortality rate, whereas, delayed PPEs were mostly monomicrobial with Gram-positive bacterias and associated with a better prognosis. In the majority of cases without broncho-pleural fistulae (BPF), success with VATS was documented, even if some patients needed secondary thoracostomy. Notably, excess mortality was associated with PPE, especially when occurring in the early course after pneumonectomy.

Methods

• Researchers performed a retrospective review, wherein, they studied the files of a series of 37 consecutive patients with PPE over a 10-year period with a special focus on microbiology, means used to treat empyema, and prognosis.

Results

• Findings demonstrated that PPE occurred within 14 days of pneumonectomy in 17 cases (early PPE) and after postoperative day 16 in 20 patients (delayed PPE).
• In 57% of cases, PPE was monomicrobial.
• Staphylococcus sp.and Streptococcus sp. were identified as the most frequent pathogens.
• In patients with early vs delayed PPE, polymicrobial empyema was more frequent (65% vs 25%; p=0.02).
• Data also reported that video-assisted thoracoscopic approach for cavity lavage was performed in 22 patients without broncho-pleural fistulae (BPF), associated with antimicrobial therapy and drainage, and was successful in 13 cases (59%).
• An open window thoracostomy was performed on 17 patients (46%).
• Researchers found that overall 90-day post empyema mortality was 19%, with 6 deaths due to empyema in the early PPE group (35%), vs 1 (5%) in the delayed PPE group (p=0.02).