Advanced stage empyemas in community-acquired pneumonia: how hospital re-organization during the Covid-19 pandemic affected the increase in surgically treated cases
Keywords:
pleural empyema - Covid-19 - hospital organizationAbstract
The cause of pleural empyema is bacterial pneumonia and three stages has been described in the evolution of this disease: exudative, fibrino-purulent and organizational phases. The first therapeutic intervention is the antibiotic therapy; where pharmacological therapy alone is not sufficient to eradicate the infection, it is also necessary a surgical treatment. Since the province of Piacenza having been in the epicenter area during the first Sars-Cov 2 pandemic wave in March 2020 and the number of patients with Covid-related pneumonia required invasive and non-invasive respiratory support, had a considerable organizational impact on pulmonology and respiratory unit, hindering an optimal treatment of the bacterial pneumonia both in community as well as in the hospital.
Among the many "collateral" damages of the epidemiological wave of the infection with Sars Cov-2, we have been able to observe in our Hospital, also an increase of pulmonary empyemas diagnosed at an advanced stage for what we believe to be organizational and social causes directly related to the pandemic: in order to cope with the emergency the Unit of Pneumology has been since March nearly uninterruptedly dedicated to the exclusive treatment of covid patients so the pneumologist has been removed due to the need from outpatient and residential management of general pneumology
References
Dean NC, Griffith PP, Sorensen J, McCauley L, Jones BE, Lee YC Pleural effusions at first emergency department encounter predict worse clinical outcomes in pneumonia patients. Chest, 2016; 149(6):1509-15
Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J, 2016; 10(5):1150–1156
Shen K.R., Bribriesco A., Crabtree T., et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. The Journal of Thoracic and Cardiovascular Surgery, 2017;153(6):129-146
Ala Eldin H. Ahmed and Tariq E. Yacoub. Empyema Thoracis. Clin Med Insights Circ Respir Pulm Med, 2010; 4: 1–8.
Wait MA, Sharma S, Hohn J, Dal Nogare A. A randomized trial of empyema therapy. Chest, 1997;111:1548-1551
Porcel JM, Valencia H, Bielsa S. Factors influencing pleural drainage in parapneumonic effusions. Rev Clin Esp 2016; 216 :361-366.
Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH, Davies RJ. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med 2006;174:817-823.
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Publisher
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
