Antibiotic resistance in empyema thoracis: clinical outcomes and contributing factors in a tertiary care setting in Pakistan

Objectives

This study aimed to determine the antibiotic resistance patterns, clinical outcomes, and factors influencing treatment outcomes in patients with empyema thoracis (ET).

Methods

A total of 294 patients with ET (65.9% males, 34.1% females; mean age 47.9 ± 17.1 years) were included. Predisposing factors, comorbidities, microbial pathogens, and antibiotic resistance patterns were analyzed. Clinical improvement and associations with demographic and clinical variables were statistically evaluated.

Results

Pulmonary parenchymal infection (68.2%) was the most common predisposing factor, followed by postoperative empyema (11.2%). Rural residency (64.3%), biomass exposure (71.0%), and non-smoking status (75.2%) were prevalent. Community-acquired empyema was observed in 72.2% of cases, and clinical improvement was achieved in 59.18%. Klebsiella pneumoniae (45 cases), Escherichia coli (32 cases), and Citrobactor freundii (23 cases) were the most frequently isolated pathogens. Significant associations were found between no clinical improvement and male gender, rural residency, smoking, biomass exposure, and microorganism presence (P <0.05). Antibiotic susceptibility testing highlighted variable resistance patterns.

Conclusions

ET remains a significant clinical challenge, with community-acquired infections and K. pneumoniae predominating. Effective antibiotic stewardship and targeted management strategies are essential to improving outcomes, especially in high-risk populations.