Microbiology of pleural infection according to setting

Background: Pleural infection is an important cause of morbidity. Timely start of antibiotic treatment is necessary. Successful empiric treatment relies on knowledge of local bectoriologic pattern of infection. The bacteriologic niche is known to differ between hospital acquired (HA) and community acquired (CA) infections. Methods: We conducted a literature search on pleural infection bacteriology. MEDLINE and EMBASE were searched for all papers on the subject between 1997-2017. Papers reporting on paediatric or tuberculous patients were excluded. Results: 275 papers were found to include novel and relevant microbiology data. Of those, 11 papers specified what the setting of the infection was (CA vs. HA). The total number of patients reported was 1523 (1097 with CA vs 426 with HA infection). The median (IQR) per cent positivity of pleural fluid culture was 69% (48-77%). The median (IQR) of the mean ages of patients was 64 (55-66) years. Table one displays a comparison between the 2 groups. The Viridans Strept. group comprises the Strept. milleri subgroup and other microaerophilic strept. Conclusion: There are considerable differences of bacteriology pattern between CA and HA pleural infections. Streptococcal infection is the most common in CA, while Staph. aureus and enteric bacteria are more common in the hospital setting.