Diagnostic and prognostic implications of bacteremia in patients with complicated pleural infection

TL;DR

Bacteremia occurs in 7% of patients with complicated pleural infection, but it does not significantly affect mortality and offers limited diagnostic value compared to pleural fluid culture.

Contribution

The study identifies specific patient characteristics where blood culture testing may be more beneficial in complicated pleural infections.

Findings

Bacteremia was found in 7% of patients with complicated pleural infection.

Blood culture added only 2% more pathogen identification compared to pleural fluid culture.

RAPID score ≥5 was the only factor significantly associated with overall mortality.

Abstract

The clinical significance of bacteremia in patients with complicated pleural infection is still uncertain. We aimed to examine the incidence and clinical significance of bacteremia in patients with complicated pleural infection.

This retrospective study comprised of consecutive patients who received pleural drainage due to complicated parapneumonic effusion or empyema. The clinical, laboratory, and radiologic data and clinical outcome were compared between patients with and without bacteremia. Additionally, the factors associated with overall mortality were evaluated in these patients.

Of 341 patients included in the analysis, 25 (7 %) had a positive blood culture. Blood culture testing added 2 % identification of causative pathogen compared to pleural fluid culture alone. By multivariable analysis, radiologic features of cavitary lesion, a RAPID score≥5, and a positive microbial culture in pleural fluid were independently associated with bacteremia. Despite these clinical distinctions, there was ultimately no significant difference in in-hospital mortality between patients with and without bacteremia (3 vs. 4 %, p=1.0). The only factor significantly associated with overall mortality among patients with complicated pleural infections was a higher RAPID score [HR=1.96 (95 % CI=1.35–2.84)].

The rate of bacteremia in patients with complicated pleural infection was 7 %. Blood culture testing demonstrated limited diagnostic yield and had minimal impact on clinical outcomes compared to pleural fluid culture. Therefore, it seems that blood culture testing is more advantageous for specific patients with suspected pleural infection who have cavitary lesions or a RAPID score≥5.