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Emergence of parapneumonic empyema in the USA
#MMPMID21617169
Grijalva CG
; Zhu Y
; Nuorti JP
; Griffin MR
Thorax
2011[Aug]; 66
(8
): 663-8
PMID21617169
show ga
BACKGROUND: Although recent reports suggest that the incidence of parapneumonic
empyema has increased in several regions of the USA, national trends in disease
burden are unknown. National trends in the incidence of parapneumonic empyema
hospitalisations and changes in empyema by associated pathogens were examined.
METHODS: National hospitalisation data (1996-2008) were analysed and rates
estimated using census estimates as denominators. Incidence rate ratios (IRR)
compared 2008 with 1996 rates. Discharge diagnosis codes were used to
characterise pathogens associated with empyema hospitalisations. RESULTS:
Overall, national parapneumonic empyema-related hospitalisation rates increased
from 3.04 per 100,000 in 1996 to 5.98 per 100,000 in 2008, a 2.0-fold increase
(95% CI 1.8 to 2.1). The increases were observed among children (IRR 1.9 (95% CI
1.4 to 2.7)) and adults aged 18-39, 40-64 and ?65 years (IRR 1.8 (95% CI 1.5 to
2.1), 2.0 (95% CI 1.6 to 3.1) and 1.7 (95% CI 1.5 to 2.0), respectively).
Overall, pneumococcal empyema rates remained relatively stable in all age groups
whereas streptococcal- (non-pneumococcal) and staphylococcal-related empyema
rates increased 1.9-fold and 3.3-fold, respectively, with consistent increases
across age groups. The overall in-hospital case fatality ratio for parapneumonic
empyema-related hospitalisations was 8.0% (95% CI 6.4% to 9.5%) in 1996 and 7.2%
(95% CI 6.3% to 8.1%) in 2008 (p=0.395). Of the empyemas where study pathogens
were listed (37.6%), staphylococcal-related empyema had the largest absolute
increases across age groups and was associated with longer hospital stay and
higher in-hospital mortality than other empyemas. CONCLUSIONS: Although
parapneumonic empyema-related hospitalisations remained relatively rare, they
increased substantially during the study period. A number of pathogens,
especially staphylococcus, contributed to this increase.
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