1887
Volume 2025, Issue 4
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Empyema, characterized by the accumulation of pus in the pleural space, poses a significant medical challenge with diverse complications. This study aims to provide a comprehensive overview of the epidemiology, microbiological spectrum, management strategies, and outcomes of empyema patients in Qatar.

Methods: We conducted a comprehensive review of electronic medical records from all hospitals affiliated with Hamad Medical Corporation, the national healthcare system of Qatar, for patients aged 18 years and older diagnosed with empyema between January 1, 2015, and December 31, 2019.

Seventy-five empyema cases were reviewed, predominantly male (89.3%) with a mean age of 44 years. Common comorbidities included diabetes mellitus (30.7%) and a history of malignancy (20%). Pleural fluid was universally exudative, with turbidity in (55.4%) and blood staining in (16.9%). (38.7%) and Gram-negative bacteria (29.3%) were the predominant pathogens. All patients received antibiotics, with chest tube insertion as the primary intervention in 74.6%. Video-Assisted Thoracoscopic Surgery (VATS) was performed in 24% and medical thoracoscopy in 1.3%. The mortality rate was significant at 18.6%. Univariate and multivariate analyses indicated that a prior history of pneumonia ( = 0.004), pleural effusion/empyema ( = 0.024), and malignancy ( < 0.036) were significant predictors of mortality.

Streptococci were identified as the predominant pathogen in empyema cases in Qatar, with Diabetes Mellitus being the most common comorbidity. Early antibiotic therapy and chest tube insertion were key to effective management, often reducing the need for surgical interventions. Despite this, mortality remains a significant concern.

Loading

جارٍ تحميل قياسات المقالة...

/content/journals/10.5339/qmj.2025.110
٢٠٢٥-١٢-١٠
٢٠٢٥-١٢-١٥

القياسات

Loading full text...

Full text loading...

/deliver/fulltext/qmj/2025/4/qmj.2025.110.html?itemId=/content/journals/10.5339/qmj.2025.110&mimeType=html&fmt=ahah

References

  1. Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006; 3:(1):75–80. https://doi.org/10.1513/pats.200510-113JH
    [Google الباحث العلمي]
  2. Arnold DT, Hamilton FW, Morris TT, Suri T, Morley A, Frost V, et al. Epidemiology of pleural empyema in English hospitals and the impact of influenza. Eur Respir J. 2021 Jun; 57:(6):2003546. https://doi.org/10.1183/13993003.03546-2020
    [Google الباحث العلمي]
  3. Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH, Davies RJ. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006 Oct; 174:(7):817–23. https://doi.org/10.1164/rccm.200601-074OC
    [Google الباحث العلمي]
  4. Ahmed RA, Marrie TJ, Huang JQ. Thoracic empyema in patients with community-acquired pneumonia. Am J Med. 2006 Oct; 119:(10):877–83. https://doi.org/10.1016/j.amjmed.2006.03.042
    [Google الباحث العلمي]
  5. Tsang KY, Leung WS, Chan VL, Lin AW, Chu CM. Complicated parapneumonic effusion and empyema thoracis: microbiology and predictors of adverse outcomes. Hong Kong Med J. 2007 Jun; 13:(3):178–86.
    [Google الباحث العلمي]
  6. Khan FY, Alsamawi M, Yasin M, Ibrahim AS, Hamza M, Lingawi M, et al. Etiology of pleural effusion among adults in the state of Qatar: a l-year hospital-based study. East Mediterr Health J. 2011 Jul; 17:(7):611–8.
    [Google الباحث العلمي]
  7. Wozniak CJ, Paull DE, Moezzi JE, Scott RP, Anstadt MP, York VV, et al. Choice of first intervention is related to outcomes in the management of empyema. Ann Thorac Surg. 2009 May; 87:(5):1525–31.
    [Google الباحث العلمي]
  8. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23; 336:(4):243–50. https://doi.org/10.1056/NEJM199701233360402
    [Google الباحث العلمي]
  9. Iguina MM, Sharma S, Danckers M. Thoracic empyema. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2025 Jan–.
    [Google الباحث العلمي]
  10. Grillo IA, Teklu B, al-Saigh AH, Malatani TS, al Shehry MY, Batouk A, et al. Empyema thoracis in adults in Saudi Arabia. East Afr Med J. 1995 Dec; 72:(12):766–9.
    [Google الباحث العلمي]
  11. Meyer CN, Rosenlund S, Nielsen J, Friis-Møller A. Bacteriological aetiology and antimicrobial treatment of pleural empyema. Scand J Infect Dis. 2011 Mar; 43:(3):165–9. https://doi.org/10.3109/00365548.2010.536162
    [Google الباحث العلمي]
  12. Doležal J, Vejvodová Š, Vodika J, Špidlen V. Pleural empyema - single center experience. Rozhl Chir. 2018 Summer; 97:(8):379–83.
    [Google الباحث العلمي]
  13. National Planning Council . Qatar Census December 2020. Available from: https://www.psa.gov.qa/en/statistics1/StatisticsSite/Census/census2020
    [Google الباحث العلمي]
  14. Maskell NA, Davies CW, Nunn AJ, et al. U.K. Controlled trial of intrapleural streptokinase for pleural infection [N Engl J Med. 2005 May;352(20):2146]. N Engl J Med. 2005; 352:(9):865–74. https://doi.org/10.1056/NEJMoa042473
    [Google الباحث العلمي]
  15. Marks DJ, Fisk MD, Koo CY, Pavlou M, Peck L, Lee SF, et al. Thoracic empyema: a 12-year study from a UK tertiary cardiothoracic referral centre. PLoS One. 2012; 7:(1):e30074. https://doi.org/10.1371/journal.pone.0030074
    [Google الباحث العلمي]
  16. Mathur P, Leburu S, Kulothungan V. Prevalence, awareness, treatment and control of diabetes in India from the Countrywide National NCD Monitoring Survey. Front Public Health. 2022 Mar; 10:748157. https://doi.org/10.3389/fpubh.2022.748157
    [Google الباحث العلمي]
  17. Dyrhovden R, Nygaard RM, Patel R, Ulvestad E, Kommedal Ø. The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study. Clin Microbiol Infect. 2019 Aug; 25:(8):981–6. https://doi.org/10.1016/j.cmi.2018.11.030
    [Google الباحث العلمي]
  18. Alabdulla M, Reagu S, Elhassan NM, et al. Emergency department presentations of alcohol and other substance misuse: first cross-sectional national study in Qatar. BMJ Open. 2021 Oct; 11:(10):e055181. https://doi.org/10.1136/bmjopen-2021-055181
    [Google الباحث العلمي]
  19. Marmagkiolis KM, Omar M, Nikolaidis N, Politis T, Nikolaidis I, Fournogerakis S, et al. Ten-year exploratory retrospective study on empyema. Crit Care. 2008; 12:(Suppl 2):P43. https://doi.org/10.1186/cc6264
    [Google الباحث العلمي]
  20. Vaziri M, Abed O. Management of thoracic empyema: review of 112 cases. Acta Med Iran. 2012; 50:(3):203–7.
    [Google الباحث العلمي]
  21. Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?. Interact Cardiovasc Thorac Surg. 2010 Aug; 11:(2):171–7. https://doi.org/10.1510/icvts.2010.240408
    [Google الباحث العلمي]
  22. Sindgikar V, Vallabha T, Patil M, Kullolli G, Reddy S. Empyema thoracis-the role of open thoracotomy with decortication in the era of video-assisted thoracoscopic surgery. Ann Afr Surg. 2022 Oct; 19:(4):175–9.
    [Google الباحث العلمي]
  23. Chen W, Lin YC, Liang SJ, Tu CY, Chen HJ, Hang LW, et al. Hospital-acquired thoracic empyema in adults: a 5-year study. South Med J. 2009 Sep; 102:(9):909–14. https://doi.org/10.1097/SMJ.0b013e3181b22c52
    [Google الباحث العلمي]
  24. Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swinburn CR. The clinical course and management of thoracic empyema. QJM. 1996 Apr; 89:(4):285–9. https://doi.org/10.1093/qjmed/89.4.285
    [Google الباحث العلمي]
  25. Bender JM, Ampofo K, Sheng X, Pavia AT, Cannon-Albright L, Byington CL. Parapneumonic empyema deaths during past century, Utah. Emerg Infect Dis. 2009 Jan; 15:(1):44–8. https://doi.org/10.3201/eid1501.080618
    [Google الباحث العلمي]
  26. Khan JA, Lehtomäki AI, Toikkanen VJ, Ukkonen MT, Nevalainen RM, Laurikka JO. Long-term prognosis and causes of death after pleural infections. Scand J Surg. 2018 Jun; 107:(2):145–51. https://doi.org/10.1177/1457496917738868
    [Google الباحث العلمي]
  27. Chen KC, Chen HY, Lin JW, Tseng YT, Kuo SW, Huang PM, et al. Acute thoracic empyema: clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery. J Formos Med Assoc. 2014 Apr; 113:(4):210–8. https://doi.org/10.1016/j.jfma.2013.12.010
    [Google الباحث العلمي]
  28. Mwesige M, Otim P, Iranya RN, Magala JP, Makumbi TK. Outcomes of adult empyema thoracis cases managed in a tertiary hospital in Uganda: a retrospective cohort study. BMC Pulm Med. 2025 Aug; 25:(1):365. https://doi.org/10.1186/s12890-025-03861-0
    [Google الباحث العلمي]
  29. Rahman NM, Kahan BC, Miller RF, Gleeson FV, Nunn AJ, Maskell NA. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest. 2014 Apr; 145:(4):848–55. https://doi.org/10.1378/chest.13-1558
    [Google الباحث العلمي]
  30. Pulle MV, Puri HV, Asaf BB, Bishnoi S, Malik M, Kumar A. Predictors of mortality after surgery for empyema thoracis in chronic kidney disease patients. Korean J Thorac Cardiovasc Surg. 2020 Dec; 53:(6):392–9. https://doi.org/10.5090/kjtcs.20.111
    [Google الباحث العلمي]
  31. Dimitrov E, Valchev D, Minkov G, Enchev E, Yovtchev Y. Prediction of poor outcome using the urea to albumin ratio in thoracic empyema. Acta Med Litu. 2024; 31:(1):160–8. https://doi.org/10.15388/Amed.2024.31.1.21
    [Google الباحث العلمي]
  32. Yamazaki A, Ito A, Ishida T, Washio Y. Polymicrobial etiology as a prognostic factor for empyema in addition to the renal, age, purulence, infection source, and dietary factors score. Respir Investig. 2019 Nov; 57:(6):574–81. https://doi.org/10.1016/j.resinv.2019.06.008
    [Google الباحث العلمي]
/content/journals/10.5339/qmj.2025.110
Loading
/content/journals/10.5339/qmj.2025.110
Loading

جارٍ تحميل البيانات والوسائط...

  • نوع المستند: Research Article
الموضوعات الرئيسية Empyemaepidemiologymicrobiologymortalityoutcomes and Qatar

الأكثر اقتباسًا لهذا الشهر Most Cited RSS feed

هذه الخانة مطلوبة
يُرجى إدخال عنوان بريد إلكتروني صالح
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error