Abstract
Background: Pleural infection is a common and severe disease with high morbidity and mortality worldwide. Knowledge of pleural infection bacteriology remains incomplete. The TORPIDS study was designed to discover the microbiome of pleural infection and assess correlation of bacterial patterns with clinically important outcomes.
Methods: Pleural fluid samples (n=243) from the Pleural Infection Longitudinal Outcome Study (PILOT) were subjected to 16S rRNA next generation sequencing. Multivariate regression analysis was applied to investigate the link between bacterial patterns and clinical outcomes.
Results: Pleural infection was predominately polymicrobial (79% of samples) with diverse bacterial patterns observed in monomicrobial and polymicrobial disease. Mixed anaerobes and other Gram-negative bacteria predominated in polymicrobial infection whereas Streptococcus pneumoniae prevailed in monomicrobial cases. The presence of anaerobes (HR=0.46, P=0.02) or bacteria of the Streptococcus anginosus group (HR=0.43, P=0.04) was associated with better survival, while the presence (HR=5·80, P<0·001) or dominance (HR=3.97, P=0.02) of Staphylococcus aureus was linked with higher mortality. Dominance of Enterobacteriaceae was associated with higher risk of death (HR=2.79, P=0.04). No differences were detected for duration of hospitalisation and the need for surgery.
Conclusion: Polymicrobiality in pleural infection explains the requirement for broad spectrum antibiotic cover in most individuals. High mortality infection associated with Staphylococcus aureus and Enterobacteriaceae favours more aggressive but narrower spectrum antibiotic strategies.
Footnotes
Cite this article as ERJ Open Research 2022; 8: Suppl. 8, 4.
This article was presented at the 2022 ERS Lung Science Conference, in session “Poster Session 2”.
This is an ERS Lung Science Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2022