THE EMERGENCE OF PARAPNEUMONIC EMPYEMA IN THE UNITED STATES
Published Date:May 26 2011
Pubmed Central ID:PMC4820002
Funding:K01 CI000163/CI/NCPDCID CDC HHS/United States
K01 IP000163/IP/NCIRD CDC HHS/United States
TS-1454/TS/ATSDR CDC HHS/United States
Although recent reports suggest the incidence of parapneumonic empyema increased in several regions of the United States, national trends in disease burden are unknown. We examined national trends in the incidence of parapneumonic empyema hospitalizations and changes in empyema by associated pathogens.
National hospitalization data(1996–2008) were analyzed and rates estimated using Census estimates as denominators. Incidence rate ratios (IRR) compared 2008 with 1996 rates. Discharge diagnosis codes were used to characterize pathogens associated with empyema hospitalizations.
Overall, national parapneumonic empyema-related hospitalization 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: 1.8–2.1). The increases were observed among children (IRR: 1.9 [95% CI: 1.4–2.7]) and adults aged 18–39, 40–64 and ≥65 years (IRRs: 1.8 [95% CI: 1.5–2.1], 2.0 [95% CI: 1.6–3.1] and 1.7 [95% CI: 1.5–2.0], respectively). Overall pneumococcal empyema rates remained relatively stable in all age groups, whereas streptococcal (non-pneumococcal) and staphylococcal-related empyema rates increased 1.9 and 3.3-fold, respectively, with consistent increases across age groups. The overall in-hospital case fatality ratio for parapneumonic empyema-related hospitalizations was 8.0% (95% CI: 6.4–9.5) in 1996 and 7.2% (95% CI: 6.3–8.1) 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.
Although parapneumonic empyema-related hospitalizations remained relatively rare, they increased substantially during the study period. A number of pathogens, especially staphylococcus, contributed to this increase.
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