P-257SEVERE NECROTIZING PNEUMONIAS COMPLICATED WITH SECONDARY EMPYEMAS

Abstract

Objectives: Necrotizing pneumonia complicated with empyema is a lifethreatening condition that challenges all intensive care units, and respiratory and cardiothoracic surgery units. The aim of this study is to perform an epidemiological characterization of these patients, and secondly, analyse their treatment and outcomes. Methods: A retrospective analysis of a series of consecutive patients experiencing necrotizing pneumonia with empyema who presented at Padre Hurtado Hospital, Santiago, Chile was performed from February to August 2014. Their records were analysed and information regarding personal demographics (age, sex, comorbidities and risk factors), procedures performed, intraoperative findings, bacteriology, and outcomes (length of stay, need of ICU, complications, and mortality) were extracted. Results: Of the nine consecutive patients who presented to the emergency department with necrotizing pneumonia with empyema, seven (77.78%) were male. The median age was 53 (range 21-73) years. Forty-four percent presented with comorbidities (diabetes, high blood pressure, and neurological diseases). Forty-four percent presented drug abuse consumption and three (33.33%) were in a state of severe malnutrition. The median time of hospitalization was 41 (range 16-129) days. Thoracotomies were performed in eight (83.23%) of the patients. In four patients, the isolated bacteria was Enterococcus faecalis. Thoracic complications occurred in three (33.33%) patients. One patient required a lobectomy, one patient a fenestration and one (11.11%) patient died. Conclusions: necrotizing pneumonias complicated with empyema are rare, and there is no explanation as to why we have had so many cases in such a brief period of time. However, if there is an association with drug abuse, diabetes and malnutrition, we will continue to see such cases challenging our thoracic surgical team and ICUs with high morbidity and mortality.