MRSA Research Today is a free monthly online journal that collates and summarizes the latest research about MRSA, including details on methicillin-resistant staphylococcus aureus, hospitals, infection, antibiotic resistance, superbugs.

The Bacteriology of Pleural Infection by Genetic and Standard Methods and its Mortality Significance.

Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH, Davies RJ

Department of Respiratory Medicine, Southmead Hospital, Bristol, United Kingdom.

Background: Antibiotic choices for pleural infection are uncertain as its bacteriology is poorly described. Methods: Pleural fluid from 434 pleural infections underwent standard culture and a screen for bacteria by amplification and sequencing of bacterial 16S ribosomal RNA gene. Results: 50% of community acquired infections were streptococcal. 20% included anaerobic bacteria. 60% of hospital acquired infections included bacteria frequently resistant to antibiotics (MRSA 25%, Enterobacteriaceae 18%, Pseudomonas spp. 5%, enterococci 12%). Mortality was increased in hospital acquired infection (hospital 17/36, 47%, community 53/304, 17%, relative risk 4.24, 95% C.I. 2.07 to 8.69, p<0.00001, chi(2), 1 df = 17.47) and in Gram negative 10/22 (45%), S. aureus 15/34 (44%) or mixed aerobic infections 13/28 (46%), compared to streptococcal infection 23/137 (17%) and infection including anaerobic bacteria 10/49 (20%). (p<0.00001, chi(2) 4 df = 23.35). Conclusion: Pleural infection differs bacteriologically from pneumonia and requires different treatment. Antibiotics for community acquired infection should treat aerobic and anaerobic bacteria. Hospital acquired, Gram negative, S. aureus, and mixed aerobic infections have a high mortality.

Published 14 July 2006 in Am J Respir Crit Care Med.
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