RESUMEN
INTRODUCTION: The evolution of the microbial epidemiology of pleuropulmonary infections complicating community-acquired pneumonia has resulted in a change in empirical or targeted antibiotic therapy in children in the post Prevenar 13 era. The three main pathogens involved in pleural empyema in children are Streptococcus pneumoniae, Staphylococcus aureus and group A Streptococcus. METHODS: A questionnaire according to the DELPHI method was sent to experts in the field (paediatric pulmonologists and infectious disease specialists) in France with the purpose of reaching a consensus on the conservative antibiotic treatment of pleural empyema in children. Two rounds were completed as part of this DELPHI process. RESULTS: Our work has shown that in the absence of clinical signs of severity, the prescription of an intravenous monotherapy is consensual but there is no agreement on the choice of drug to use. A consensus was also reached on treatment adjustment based on the results of blood cultures, the non-systematic use of a combination therapy, the need for continued oral therapy and the lack of impact of pleural drainage on infection control. On the other hand, after the second round of DELPHI, there was no consensus on the duration of intravenous antibiotic therapy and on the treatment of severe pleural empyema, especially when caused by Staphylococci. CONCLUSIONS: The result of this work highlights the needed for new French recommendations based on the evolution of microbial epidemiology in the post PCV13 era.
Asunto(s)
Antibacterianos/uso terapéutico , Técnica Delphi , Empiema Pleural/tratamiento farmacológico , Empiema Pleural/epidemiología , Pediatría , Edad de Inicio , Antibacterianos/clasificación , Programas de Optimización del Uso de los Antimicrobianos/métodos , Programas de Optimización del Uso de los Antimicrobianos/normas , Niño , Consenso , Empiema Pleural/microbiología , Testimonio de Experto/estadística & datos numéricos , Femenino , Francia/epidemiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana/estadística & datos numéricos , Pediatría/métodos , Pediatría/normas , Derrame Pleural/tratamiento farmacológico , Derrame Pleural/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/terapiaRESUMEN
There have been no case reports of thoracic subcutaneous abscess after surgery for Mycobacterium abscessus complex associated empyema. We herein report a case of Mycobacterium abscessus subsp. abscessus (M. abscessus subsp. abscessus) induced subcutaneous abscesses following surgical treatment for concurrent M. abscessus subsp. abscessus -associated empyema and pneumothorax. A 75-year-old woman had M. abscessus subsp. abscessus -associated empyema and pneumothorax. She underwent surgical treatment of decortication and fistulectomy and suffered from M. abscessus subsp. abscessus -associated subcutaneous abscesses after thoracentesis/drainage. A multidisciplinary approach combined with surgical care, thermal therapy, and multidrug chemotherapy contributed to a successful result. An early multidisciplinary approach is believed to be important in cases of M. abscessus subsp. abscessus -associated empyema and subcutaneous abscess.
Asunto(s)
Absceso/microbiología , Empiema Pleural/microbiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium abscessus/aislamiento & purificación , Tejido Subcutáneo/patología , Absceso/diagnóstico , Absceso/terapia , Anciano , Antibacterianos/uso terapéutico , Empiema Pleural/complicaciones , Empiema Pleural/diagnóstico , Empiema Pleural/tratamiento farmacológico , Femenino , Humanos , Hipertermia Inducida/métodos , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Neumotórax/complicaciones , Neumotórax/diagnóstico , Neumotórax/microbiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/microbiología , Tejido Subcutáneo/microbiología , Tórax/diagnóstico por imagen , Tórax/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Antibacterianos/uso terapéutico , Empiema Pleural/microbiología , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/genética , Infecciones por Bacterias Grampositivas/microbiología , Linezolid/uso terapéutico , Antibacterianos/farmacología , Empiema Pleural/diagnóstico , Empiema Pleural/tratamiento farmacológico , Genes Bacterianos/genética , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Linezolid/farmacología , Masculino , Pruebas de Sensibilidad Microbiana , Taiwán/epidemiología , Donantes de Tejidos , Adulto JovenRESUMEN
In the pleural empyema (PE) treatment, not depending on introduction of multiple operative procedures and the medicinal preparations application, some issues remain unsolved, including the infection agents verification, the most rapid bronchial fistula elimination and the lung volume restoration. The EP infection agents spectrum, their sensitivity to preparations were revealed, as well as the enhanced rate of the methicillin-resistant stamms (MRSA) and the microorganisms associations verification. A reduction of the infection agents sensitivity towards "simple" antibacterial preparations was established, so the physicians, treating PE, must prescribe "hard" antibiotics, what enhances its cost.
Asunto(s)
Antibacterianos/uso terapéutico , Fístula Bronquial/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Antibacterianos/clasificación , Antibacterianos/economía , Fístula Bronquial/etiología , Fístula Bronquial/microbiología , Empiema Pleural/tratamiento farmacológico , Empiema Pleural/microbiología , Empiema Pleural/patología , Empiema Pleural/cirugía , Bacterias Gramnegativas/crecimiento & desarrollo , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/patología , Infecciones por Bacterias Gramnegativas/cirugía , Bacterias Grampositivas/crecimiento & desarrollo , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/patología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Mediciones del Volumen Pulmonar , Staphylococcus aureus Resistente a Meticilina/crecimiento & desarrollo , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Cavidad Pleural/microbiología , Cavidad Pleural/patología , Cavidad Pleural/cirugía , Neumonectomía/efectos adversos , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/patología , Infecciones Estafilocócicas/cirugíaRESUMEN
The incidence of empyema (EMP) is increasing worldwide; EMP generally occurs with pleural loculation and impaired drainage is often treated with intrapleural fibrinolytic therapy (IPFT) or surgery. A number of IPFT options are used clinically with empiric dosing and variable outcomes in adults. To evaluate mechanisms governing intrapleural fibrinolysis and disease outcomes, models of Pasteurella multocida and Streptococcus pneumoniae were generated in rabbits and the animals were treated with either human tissue (tPA) plasminogen activator or prourokinase (scuPA). Rabbit EMP was characterized by the development of pleural adhesions detectable by chest ultrasonography and fibrinous coating of the pleura. Similar to human EMP, rabbits with EMP accumulated sizable, 20- to 40-ml fibrinopurulent pleural effusions associated with extensive intrapleural organization, significantly increased pleural thickness, suppression of fibrinolytic and plasminogen-activating activities, and accumulation of high levels of plasminogen activator inhibitor 1, plasminogen, and extracellular DNA. IPFT with tPA (0.145 mg/kg) or scuPA (0.5 mg/kg) was ineffective in rabbit EMP (n = 9 and 3 for P. multocida and S. pneumoniae, respectively); 2 mg/kg tPA or scuPA IPFT (n = 5) effectively cleared S. pneumoniae-induced EMP collections in 24 h with no bleeding observed. Although intrapleural fibrinolytic activity for up to 40 min after IPFT was similar for effective and ineffective doses of fibrinolysin, it was lower for tPA than for scuPA treatments. These results demonstrate similarities between rabbit and human EMP, the importance of pleural fluid PAI-1 activity, and levels of plasminogen in the regulation of intrapleural fibrinolysis and illustrate the dose dependency of IPFT outcomes in EMP.
Asunto(s)
Empiema Pleural/tratamiento farmacológico , Fibrinolíticos/administración & dosificación , Infecciones por Pasteurella/tratamiento farmacológico , Infecciones Neumocócicas/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificación , Animales , Relación Dosis-Respuesta a Droga , Evaluación Preclínica de Medicamentos , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/microbiología , Femenino , Humanos , Infecciones por Pasteurella/microbiología , Pasteurella multocida/fisiología , Pleura/diagnóstico por imagen , Pleura/microbiología , Pleura/patología , Infecciones Neumocócicas/microbiología , Conejos , Proteínas Recombinantes/administración & dosificación , Streptococcus pneumoniae/fisiologíaRESUMEN
OBJECTIVES: Pleural empyema is a serious complication of pneumonia, the optimal therapy of which is still unknown. The objective of this study was to evaluate the use of moxifloxacin in this condition. METHODS: Pleural empyema was induced in rabbits by intrapleural administration of Pasteurella multocida (10(5-6) cfu) or turpentine (0.3 mL) followed 3 h later by instillation of Streptococcus pneumoniae (ATCC 49619) (10(6) cfu) into the pleural cavity. The MICs of moxifloxacin for S. pneumoniae and P. multocida were 0.4 and 0.05 mg/L, respectively. Starting 30 h following S. pneumoniae challenge intramuscular moxifloxacin 12.5 and 25 mg/kg was administered x 4 (every 12 h). Pleural empyema fluid samples were obtained for bacterial count at 12 h intervals following the first three moxifloxacin administrations. Moxifloxacin levels in pleural empyema and serum samples were obtained at 0, 30, 60, 120, 240, 360 and 480 min and 12 h after the 4th dose and determined by bioassay. RESULTS: In control animals, S. pneumoniae (and P. multocida) persisted in the pleural empyema. S. pneumoniae also persisted in the pleural empyema fluid when moxifloxacin was administered at 12.5 mg/kg (x4 administrations). Mean serum and pleural empyema peak moxifloxacin levels (following the 25 mg/kg dose) were 7.6 (+/-3.2) and 4.8 (+/-2.5) mg/L, respectively. Pleural empyema peak moxifloxacin concentration lagged 1 h after serum moxifloxacin. Serum and pleural empyema half-lives were approximately 1.5 and approximately 6 h, respectively. Serum AUC(1-12) was 29.4 (+/-6.8) mg.h/L and serum area under the inhibitory concentration curve (AUIC) was 73.5 mg.h/L. Pleural empyema AUC(1-12) was 34.3 (+/-11.7) mg/L and pleural empyema AUIC was 85.8 mg.h/L. S. pneumoniae was eradicated from pleural empyema following a single dose of moxifloxacin 25 mg/kg in 52% of the animals and in 96% following four doses. Moxifloxacin was also effective in eradication of P. multocida. The rate of pleural empyema sterilization was related to moxifloxacin serum AUIC (r = 0.82) as well as serum peak moxifloxacin level (r = 0.84), but not to pleural empyema AUIC (r = 0.19) or pleural empyema peak levels. The results were similar for both methods of induction of pleural empyema. CONCLUSIONS: Moxifloxacin appears to penetrate well into experimental pleural empyema and effectively sterilize it from S. pneumoniae. Sterilization of S. pneumoniae is related to serum AUIC rather than to moxifloxacin pharmacokinetics in pleural empyema.
Asunto(s)
Antiinfecciosos/uso terapéutico , Compuestos Aza , Modelos Animales de Enfermedad , Empiema Pleural/tratamiento farmacológico , Fluoroquinolonas , Infecciones Neumocócicas/tratamiento farmacológico , Quinolinas , Animales , Antiinfecciosos/metabolismo , Empiema Pleural/metabolismo , Masculino , Moxifloxacino , Pleura/efectos de los fármacos , Infecciones Neumocócicas/metabolismo , Conejos , Trementina/toxicidadAsunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Empiema Pleural/tratamiento farmacológico , Absceso Pulmonar/tratamiento farmacológico , Oxitocina/uso terapéutico , Antibacterianos/administración & dosificación , Infecciones Bacterianas/microbiología , Quimioterapia Combinada , Empiema Pleural/microbiología , Humanos , Absceso Pulmonar/microbiología , Pruebas de Sensibilidad Microbiana , Oxitocina/administración & dosificación , Resultado del TratamientoRESUMEN
Spontaneous bacterial empyema is a complication of hepatic hydrothorax in cirrhotic patients. The pathogen, clinical course and treatment strategy are different to the empyema secondary to pneumonia. A 54-year-old man, who was a cirrhotic patient with hepatic hydrothorax, was admitted to National Taiwan University Hospital for fever, dyspnea and right side pleuritic pain. The image study revealed massive right pleural effusion and no evidence of pneumonia. The culture of pleural effusion yielded Aeromonas veronii biotype sobria. The diagnosis of spontaneous bacterial empyema caused by Aeromonas veronii biotype sobria was established. To our best knowledge, Aeromonas veronii biotype sobria had never been reported in English literature as the causative pathogen of spontaneous bacterial empyema.
Asunto(s)
Aeromonas/aislamiento & purificación , Cefotaxima/uso terapéutico , Cefalosporinas/uso terapéutico , Empiema Pleural/diagnóstico , Aeromonas/efectos de los fármacos , Cefotaxima/farmacología , Cefalosporinas/farmacología , Empiema Pleural/tratamiento farmacológico , Empiema Pleural/microbiología , Hepatitis B Crónica/complicaciones , Humanos , Hidrotórax/etiología , Cirrosis Hepática/complicaciones , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana EdadAsunto(s)
Antiinfecciosos/uso terapéutico , Ciprofloxacina/uso terapéutico , Empiema Pleural/microbiología , Infecciones por Salmonella/microbiología , Salmonella enteritidis/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/tratamiento farmacológico , Humanos , Masculino , Infecciones por Salmonella/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
The paper summarises the experience gained in the use of immozymase in tuberculous patients to advance the disease diagnosis and treatment. Immozymase proved valuable in obtaining sputum enriched with M. tuberculosis in patients who were previously considered noncarriers. M. tuberculosis became detectable in 28.3% of them. Immozymase instillations of the urethra before its massage for stimulation of prostatic secretion led to getting secretion in all the patients (0.35 ml, on the average). Immuzymase inhalations were used in the treatment of purulent bronchitis in patients with destructive pulmonary tuberculosis in conservative and preoperative regimens. Postoperative immozymase inhalations promoted prevention of pleuropulmonary complications. Open treatment of the caverns with immozymase after cavernotomy shortens the treatment duration. Positive results were also reached in the treatment of pleural empyema.