Epidemiology of pleural infections in Taiwan from 1997 through 2008

Authors

  • HSIU-NIEN SHEN,

    Corresponding author
    1. Departments of Intensive Care Medicine and
    2. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, and
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  • CHIN-LI LU,

    1. Medical Research, Chi Mei Medical Center, Yong-Kang Region,
    2. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, and
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  • CHUNG-YI LI

    1. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, and
    2. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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Hsiu-Nien Shen, Department of Intensive Care Medicine, Chi Mei Medical Center, No. 901 Chung-Hwa Road, Yong-Kang District, Tainan, Taiwan. Email: hsiunian@gmail.com

ABSTRACT

Background and objective:  Population-based data on pleural infections are limited. This study describes the temporal trends in the incidence, management and outcomes of pleural infections in Taiwan.

Methods:  The Taiwan National Health Insurance Research Database was used to analyse data on 26 385 patients with a first episode of pleural infection between 1997 and 2008.

Results:  During the study period, the median age of the patients increased from 60 to 65 years. The majority of patients were men (75%); this proportion remained constant over time. The standardized annual incidence of pleural infection increased from 5.2 per 100 000 in 1997 and reached a plateau of 8.4 to 9.6 per 100 000 between 2002 and 2008. Over time, there was an increase in the use of computed tomography (from 47.3% in 1997–1998 to 59.4% in 2007–2008), pigtail catheters (from 1.5% to 18.9%), fibrinolytics (from 0.9% to 9.3%) and surgery (from 27.7% to 33.6%), to treat pleural infections. Furthermore, the use of life-support resources, including haemodialysis, mechanical ventilation and intensive care, also increased by 3.1%, 11.0% and 12.8%, respectively. Median hospital charges per patient increased by 63.6% over the 12 years. Although the proportion of patients with organ dysfunction (i.e. severe sepsis) increased from 26.5% to 47.7%, 30-day mortality decreased from 15.0% to 13.1% (P-value for trend = 0.001).

Conclusions:  These findings suggest that advances in the management of pleural infections and subsequent severe sepsis may have led to a reduction in the risk of short-term mortality in Taiwan.

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