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A Comparative Study of Community- and Nursing Home-Acquired Empyema Thoracis

Authors

  • Ali A. El Solh MD, MPH,

    1. From the *Division of Pulmonary, Critical Care, and Sleep Medicine, Western New York Respiratory Research Center, Buffalo, New YorkDepartment of Medicine, Division of Geriatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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  • Ahmad Alhajjhasan MD,

    1. From the *Division of Pulmonary, Critical Care, and Sleep Medicine, Western New York Respiratory Research Center, Buffalo, New YorkDepartment of Medicine, Division of Geriatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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  • Fadi H. Ramadan MD,

    1. From the *Division of Pulmonary, Critical Care, and Sleep Medicine, Western New York Respiratory Research Center, Buffalo, New YorkDepartment of Medicine, Division of Geriatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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  • Lilibeth A. Pineda MD

    1. From the *Division of Pulmonary, Critical Care, and Sleep Medicine, Western New York Respiratory Research Center, Buffalo, New YorkDepartment of Medicine, Division of Geriatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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Address correspondence to Ali El Solh, MD, MPH, Division of Pulmonary, Critical Care, and Sleep Medicine, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215. E-mail: solh@buffalo.edu

Abstract

OBJECTIVES: To compare the clinical presentation, microbiological features, and outcomes of patients with community-acquired empyema (CAE) with those of patients with nursing home-acquired empyema (NHAE).

DESIGN: A retrospective observational study.

SETTING: Three tertiary care centers.

PARTICIPANTS: One hundred fourteen patients admitted from the community and 55 patients transferred from nursing homes.

MEASUREMENTS: Baseline sociodemographic information, activities of daily living, Charlson Comorbidity Index score, and clinica, and microbiologic data were obtained. Outcome was assessed at hospital discharge and 6 months postdischarge.

RESULTS: Patients admitted from nursing homes had a delayed presentation, with dyspnea, weight loss, and anemia as the predominant manifestation. Patients with CAE presented more acutely, with fever, cough, and chest pain. Anaerobic organisms were more commonly isolated from patients with NHAE. The success rate of nonsurgical intervention was significantly lower for the NHAE patients than for the CAE group (39% vs 63; P=.01). In-hospital mortality was not significantly different between the two groups (NHAE, 18%; CAE, 8%; P=.09). In a Cox regression analysis, preadmission functional status (hazard ratio (HR)=1.26, 95% confidence interval (CI)=1.19–1.4; P<.001) and surgical intervention (HR=0.47, 95% CI=0.24–0.92; P=.03) were the only variables highly correlated with long-term outcome.

CONCLUSION: Patients admitted with NHAE have distinctly different clinical and microbiological presentation from that of patients with CAE. Because of the delayed presentation in patients with NHAE, medical treatment alone may be associated with higher rate of failure. Surgical therapy should be considered for selected cases, with the aim of improving long-term survival.

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