Clinical profile, etiology, management and outcome of empyema thoracis associated with COVID-19 infection: A systematic review of published case reports

Abstract

Objective: To explore the clinical features, diagnosis, etiology, treatment, and outcomes of COVID-19 related empyema. Methods: Using PRISMA statement, a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases. The collected data included demographics, clinical manifestations, diagnostic findings, treatment, and outcomes. Results: Thirty-six case reports were identified with 43 cases of empyema. The included cases had a median age of 55 years (range: 12-78 years) and 79.1% (34/43) were males. The majority of cases presented during hospitalization for management of acute COVID-19 infection (29/43, 67.4%) and Charlson comorbidity index <3 (40/43, 93.0%). Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid (9/43, 20.9%) and 16.3% of the cases (7/43) had polymicrobial infections. Chest drainage was performed in all cases while surgery was indicated in 24 cases (55.8%). The most common complication of COVID-19-related empyema was broncho-pleural fistula (2/43, 4.7%). The mortality rate was 23.3% (10/43). Sepsis and/or multi-organ failure were the most commonly reported causes of death. On univariate analysis, no statistically significant risk factor for mortality was identified. Conclusions: COVID-19-associated empyema has a variety of predisposing factors, time of presentation, clinical features, and causative organisms. Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage. Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.

Keywords

• covid-19; sars-cov-2; empyema; microbiology; thoracic surgery