Pleural Aerobic Culture Status, Clinical Phenotypes, and In-Hospital Outcomes in Adult Pleural Infection: A Retro-Spective Cohort Study.

@article{balica2026pleural,
  title = {{Pleural Aerobic Culture Status, Clinical Phenotypes, and In-Hospital Outcomes in Adult Pleural Infection: A Retro-Spective Cohort Study.}},
  author = {Madalina Alexandra Balica and Catalin Balan and Norbert Wellmann and Lavinia Balan and Norberth-Istvan Varga and Daniela Teodora Marti and Razvan Susan and Ovidiu Rosca and Lavinia Davidescu and Ovidiu Fira-Mladinescu},
  journal = {Medicina (Kaunas, Lithuania)},
  year = {2026},
  month = oct,
  doi = {10.3390/medicina62102013},
  url = {https://europepmc.org/article/MED/42942544},
  note = {CC BY},
}

TY  - JOUR
TI  - Pleural Aerobic Culture Status, Clinical Phenotypes, and In-Hospital Outcomes in Adult Pleural Infection: A Retro-Spective Cohort Study.
AU  - Madalina Alexandra Balica
AU  - Catalin Balan
AU  - Norbert Wellmann
AU  - Lavinia Balan
AU  - Norberth-Istvan Varga
AU  - Daniela Teodora Marti
AU  - Razvan Susan
AU  - Ovidiu Rosca
AU  - Lavinia Davidescu
AU  - Ovidiu Fira-Mladinescu
PY  - 2026
DA  - 2026/10/18
JO  - Medicina (Kaunas, Lithuania)
DO  - 10.3390/medicina62102013
UR  - https://europepmc.org/article/MED/42942544
AB  - Background and Objectives: Pleural infection is heterogeneous, and the clinical meaning of a positive pleural culture remains uncertain. We compared adults with positive and negative aerobic pleural-fluid cultures and examined associations with major in-hospital events. Materials and Methods: This retrospective, single-center, case-ascertained cohort included adults hospitalized with bacterial pleural infection in Western Romania during 2017-2025. The primary analytic cohort was restricted to patients whose first clinically relevant pleural specimen had an interpretable aerobic culture. Pleural fluid (PF)-positive and PF-negative status was defined exclusively by that result; unperformed tests and operative specimens were not used for classification. The composite outcome comprised in-hospital death, intensive-care unit (ICU) admission/transfer, or thoracic surgery/surgical transfer. Prespecified covariates were entered simultaneously in logistic regression. Results: Of 317 included patients, 276 had an interpretable aerobic pleural culture: 127 (46.0%) were PF-positive and 149 (54.0%) were PF-negative. PF-positive patients were more often institutionalized, had chronic kidney disease, nosocomial infection, frank empyema, and lower pleural-fluid pH and glucose. Streptococci predominated in community-acquired infection, whereas Gram-negative organisms and multidrug-resistant phenotypes were more frequent in healthcare-associated/nosocomial episodes. The composite occurred in 60/127 (47.2%) PF-positive and 51/149 (34.2%) PF-negative patients (OR 1.72, 95% CI 1.06-2.80). The adjusted PF-positive estimate remained imprecise (aOR 1.60, 95% CI 0.94-2.74; p = 0.084), whereas healthcare-associated/nosocomial acquisition was associated with the composite (aOR 1.76, 95% CI 1.03-3.00; p = 0.038). In a sensitivity analysis restricted to 249 patients whose pleural sampling preceded all recorded outcome components, the adjusted association remained imprecise (aOR 1.54, 95% CI 0.86-2.76). Conclusions: A positive aerobic pleural culture identified a distinct high-risk phenotype and influenced antimicrobial management, but its independent association with the heterogeneous in-hospital composite remained uncertain. Acquisition setting and local resistance ecology should guide empirical therapy, and outcome timing should be reported explicitly in future studies.
SN  - 1010-660X
SN  - 1648-9144
ER  -