Severity assessment tools to guide ICU admission in community-acquired pneumonia: Systematic review and meta-analysis. 1997 336:243–50.Ĭhalmers JD, Mandal P, Singanayagam A, Akram AR, Choudhury G, Scally C, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. The clinical course and management of thoracic empyema. 2006 3(1):75–80.įerguson AD, Prescott RJ, Selkon JB, Watson D, Swinburn CR. Light RW, Girard WN, Jenkinson SG, George RB. Management of pleural infection in adults: British Thoracic Society pleural disease guidelines. Diagnosis and management of parapneumonic effusions and empyema. The incidence and clinical correlates of parapneumonic effusions in pneumococcal pneumonia. This review summarises the data on the incidence and clinical predictors of pleural infection in patients with pneumonia, and considers the implications of these risk factors for management and what we know of the pathophysiology of parapneumonic effusions. Intriguingly, patients with chronic obstructive pulmonary disease have a low risk of pleural infection, despite a high frequency of pneumonia, and it has been speculated that bacterial colonisation or inhaled corticosteroids may play a protective role in these patients. Patients with pleural infection after pneumonia are younger, more frequently have a history of alcohol or substance abuse, and have evidence of marked systemic inflammation, with higher levels of C-reactive protein, leucocyte counts and platelet counts compared to patients with pneumonia who do not develop pleural complications. It was previously believed that no clinical features could identify patients at risk of pleural infection, but recent research suggests this is not the case. Clinically there is a recognised spectrum of effusions from simple parapneumonic, which typically resolve without requiring intervention other than antibiotic treatment, to complicated parapneumonic effusions associated with bacterial infection and inflammatory cell infiltration, through to empyema, with the presence of frank pus in the pleural space. The development of a pleural effusion represents a common complication of pneumonia.
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