Prevalence of pathogens causing parapneumonic effusions and empyema

Typical setting	Pathogen(s)	Overall prevalence range	Comments
Community-acquired	Streptococcus pneumoniae	10 to 20%	Common cause of community-acquired pneumonia; PPE caused by S. pneumoniae are often monomicrobial.
	Microaerophilic streptococci S. intermedius S. anginosus S. constellatus	4 to 24%	Common residents of oral flora; often associated with aspiration pneumonia and polymicrobial infection.
	Anaerobes, including: Fusobacterium nucleatum* Prevotella species Peptostreptococcus species Bacteroides species	6 to 20%	Common residents of oral flora; often associated with aspiration pneumonia and polymicrobial infection.
Hospital-acquired	Staphylococcus aureus	10 to 15%	Most common cause of hospital-acquired infections. Frequently monomicrobial and can be associated with necrotizing or cavitary pneumonia.
Hospital-acquired	Gram-negative anaerobes and aerobes including: Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa	8 to 10%	Other common causes of hospital-acquired infections. May be monomicrobial or polymicrobial, with polymicrobial infection more likely if associated with aspiration pneumonia. Pseudomonas may be associated with necrotizing or cavitary pneumonia.

This table outlines the prevalence of pathogens that commonly cause parapneumonic effusions and parapneumonic empyema. Other organisms, such as Mycobacteria tuberculosis, Burkholderia pseudomallei, atypical pathogens (eg, Legionella and Mycoplasma species) and fungi are uncommon causes but should be considered in endemic areas, outbreak settings, and/or in patients with specific exposures or other risk factors. Please refer to UpToDate topic text for additional detail.

* The prevalence of anaerobic parapneumonic effusion and empyema is difficult to accurately assess because anaerobes are difficult to isolate in culture. Their prevalence may be underestimated, particularly as components of polymicrobial infections.

References:

Marks DJ, Fisk MD, Koo CY, et al. Thoracic empyema: a 12-year study from a UK tertiary cardiothoracic referral centre. PLoS One 2012; 7:e30074.
Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med 2006; 174:817.
Davies HE, Davies RJ, Davies CW, BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 Suppl 2:ii41.
Lisboa T, Waterer GW, Lee YC. Pleural infection: changing bacteriology and its implications. Respirology. 2011; 16:598.
Brook I, Frazier EH. Aerobic and anaerobic microbiology of empyema. A retrospective review in two military hospitals. Chest 1993; 103:1502.

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Prevalence of pathogens causing parapneumonic effusions and empyema