A Study of Bacteriological Profile of Pleural Fluid and Antibiogram of Isolates at Pandit Dindayal Upadhyay Medical College Andhospital College, Rajkot
South Asian Journal of Research in Microbiology,
Background: The bacteriology of thoracic empyema has been changing since the introduction of antibiotics. Gram stain and culture has for decades been the “gold standard” for the detection of microorganisms in pleural fluid samples. The present retrospective study was designed to review our experience with the microbial causes of empyema and their antibiotic sensitive patterns. The knowledge of likely prevalent strains along with their antimicrobial sensitive pattern helps in the framing of antibiotic policy and better management of patients.
Materials and Methods: This descriptive study was including 500 cases suspected of bacteriological infection of pleural fluid in patients admitted in ward of PDU Government Hospital, Rajkot. The performa include serial number, register number, age, sex, ward, clinical features of patients and investigation. All the samples were inoculated into Blood agar and MacConkey agar and Nutrient agar. All the plates were incubated aerobically at 370 C and results were read after 24 hours. If no growth present it is further incubated for next 24 hours. One smear was prepared on clean glass slide, then air dried and was heat fixed. Gram staining was done by standard technique.
Results: This study include 500 cases of pleural effusion from January 2015 to July 2016, out of which 87 cases show positive Bacterial culture growth and 232 cases were adenosine deaminase positive. In total 87 positive bacterial cultures, 20(22%) show bacterial pathogens in gram stain. Total positive culture found in 17.4%. Among them; most common Bacteria isolated was Pseudomonas aeruginosa in 40 (45%) patients, this was followed by Klebsiella pneumonaie in 21 (24%), Staphylococcus aureus in 10 (11.49%), Acinetobacter spp. in 4 (4.59%), Proteus spp.in 3 (3.44%) and Providencia in 1 (1.14%).
Conclusion: Pleural space infection continues to be prevalent in our country particularly in the lower socioeconomic strata due to the delay in seeking medical care, inappropriate antibiotics and dosages and duration of antibiotic treatment. All gram positive bacteria isolate were 100% sensitivity to Rifampicin, Vancomycin, Linezolid.
- Bacterial culture growth
- pleural space infection
- Pseudomonas aeruginosa
- thoracic empyema
How to Cite
Richard W. Light disorders of pleura and mediastinum. Harrisons principles of internal medicine 17th edition. 2;1658-1660.
Light RW. Para pneumonic Effusions and Empyema In: Light RW. (Editor). Pleural Diseases, 5th ed. Lippincott Williams & Wilkins, Philadelphia, PA. 2007;179-210.
Bartlett JG, Gorbach SL and Thadepalli H: Bacteriology of empyema. Lancet. 1974; 1:338–340
Brook I, Frazier EH: Aerobic and anaerobic microbiology of empyema: a retrospective review in two military hospitals. Chest. 1993;103:1502–1507
Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH and Davies RJ: The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006;174(7):817-823.
Somenath Kundu, SubhraMitra, and Soumya Das: Adult thoracic empyema: A comparative analysis of tuberculous and non-tuberculous etiology; Lung India artcle; 2011.
Murthy M, Macherla SK, Tarigopula PK: Clinical and microbiological evaluation of empyema thorasis; Asian Pac. J. Health Sci. 2016; 3(1):84-95.
Srujana Mohanty, Arti Kapil, Bimal K Das.Bacteriology of parapneumonic pleural effusions in an Indian hospital: Trop Doct. 2007;37(4):228-229.
Gupta S K, Kishan J,Singh S P, Review of one hundred cases of Empyema thoracis; Indian J Chest Dis Allied Sci. 1989; 31(1):15-20.
Ferrer A, Osset J, Alegre J, Suriñach JM, Crespo E, Fernández de Sevilla T, et al, Prospective clinical and microbiological study of pleural effusions. Eur J Clin Microbiol Infect Dis. 1999;18(4):237-41.
Barnes TW, Olson EJ, Morgenthaler TI, Edson RS, Decker PA, Ryu JH. Low yield of microbiologic studies on pleural fluid specimens. Chest. 2005;127(3): 916-21.
Dass R,Deka NM,Barman H, Duwarah SG,Khyriem AB, Sailia MK, Empyema thoracis: analysis of 150 cases from a tertiary carecentre in north East India: Indian J Paediatr 2011;78(11):131-7.
Ramana B V, Chaudhary A, Bhagyalaxmi M: Bacteriology of pleural fluid infections at a tertiary care hospital; IJPRBS. 2012;1 (3):373-379.
Porcel M, Vázquez P, Vives M, Nogués A, Falguera M, Manonelles A. Pleural Space Infections: Microbiologic and Fluid Characteristics in 84 Patients. The Internet Journal of Pulmonary Medicine. 2003; 3:1.
Delikaris PG, Conlan AA, Abramor E, Hurwitz SS, Studii R. Empyema thoracis--a prospective study on 73 patients. S Afr Med J.1984;14;65(2):47-9.
Jain S, Banavaliker JN: EMPYEMA THORACIS: Bacteriological analysis of pleural fluid from the largest chest hospital in Delhi; IOSR Journal of Dental and Medical Sciences. 2013;3(6): 46-51.
Goel N, Chaudhary U, Aggarwal R, Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit. Indian J Crit Care Med. 2009;13:148-51;55(2): 47-51.
Chen KY, Hsueh PR, Liaw YS, Yang PC, Luh KT.A 10-year experience with bacteriology of acute thoracic empyema: emphasis on Klebsiella pneumoniae in patients with diabetes mellitus; Chest. 2000;117 (6):1685-9.
Amit Banga, GC Khilnani, SK Sharma, AB Dey, Naveet Wig and Namrata Banga, A study of empyema thoracis and role of intrapleural streptokinase in its management: BMC Infectious Diseases. 2004;4:19.
Deep Gagneja, Nidhi Goel, Ritu Aggarwal, and Uma Chaudhary Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: A 5-year study,Indian J Crit Care Med. 2011;15(3): 164–167.
Mishra SK, Kattel HP, Acharya J, Shah NP, Shah AS, Sherch and JB, Rijal BP, Pokhrel BM. Recent trend of bacterial aetiology of lower respiratory tract infections in a tertiary care center of Nepal. Int J Infect Microbiol. 2012;1(1): 3-8.
Okesola AO, Ige OM. Trends in Bacterial Pathogens of Lower Respiratory Tract Infections. Indian J Chest Dis Allied Sci. 2008;50:269-272.
Ahmed MS, Jakribettu RP, Meletath SK, Arya B, Vpa S. Lower respiratory tract infections(LRTIS) :An insight into the prevalence and the antibiogram of the gram negative, respiratory bacterial agents. Journal of Clinical Diagnostic and research. 2013;7(2):253-256
Goel N, Chaudhary U, Aggarwal R, and Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit. Indian J Crit Care Med. 2009; 13(3):148–51.
Bajpai T, Shrivastav G, Bhatambare GS, Deshmukh A. Chitnis B, V. Microbiological profile of lower respiratory tract infections in neurological intensive care unit of tertiary care center from central India. Journal of basic and clinical pharmacy. 2013;4 (3): 51-5.
Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusions: An aid to differential diagnosis. Br Med J 1978;2:1751 2.
Ocana I, Martinez-Vazquez JM, Segura RM, Fernandez-De-Sevilla T, Capdevila JA. Adenosine deaminase in pleural fluids. Test for diagnosis of tuberculous pleural effusion. Chest. 1983;84(1):51-53.
Fontan Bueso J, Verea Hernando H, Garcia-Buela JP, Dominguez Juncal L, Martin Egana MT, Montero Martinez MC. Diagnostic value of simultaneous determination of pleural adenosine deaminase and pleural lysozyme/serum lysozyme ratio in pleural effusions. Chest. 1988;93(2):303-307.
Perez-Rodriguez E, Jimenez Castro D. The use of adenosine deaminase and adenosine deaminase isoenzymes in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med. 2000;6(4):259-266.
Jamenez DG. Diaz Nuevo and R.W Light: Diagnostic value of ADA in Non-TB Lymphocytic pleural effusions; 2003.
Strankinga WF. Adenosine deaminase activity in tuberculous pleural effusions: a diagnostic test. Tubercle. 1987;68(2) :137-140.
Alatas F, Uslu S, Moral H, Alatas O, Metintas M, Erginel S, et al. Serum adenosine deaminase activity in pulmonary tuberculosis]. Tuberk Toraks. 2003;51 (3):277-81.
Tian RX, Gao ZC. [Clinical investigation of the diagnostic value of interferon-gamma, interleukin-12 and adenosine deaminase isoenzyme in tuberculous pleurisy]. Zhonghua Jie He He Hu Xi ZaZhi. 2004;27(7):435-8.
Aoe K, Hiraki A, Murakami T. Diagnosis and treatment of tuberculous pleurisy--with special reference to the significance of measurement of pleural fluid cytokines. Kekkaku. 2004;79(4):289-95.
Abstract View: 112 times
PDF Download: 36 times