{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:54:35Z","timestamp":1792446875186,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Department of Microbiology, Haukeland University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,17]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Many community-acquired pleural infections are caused by facultative and anaerobic bacteria from the human oral microbiota. The epidemiology, clinical characteristics, pathogenesis, and etiology of such infections are little studied. The aim of the present prospective multicenter cohort study was to provide a thorough microbiological and clinical characterization of such oral-type pleural infections and to improve our understanding of the underlying etiology and associated risk factors.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Over a 2-year period, we included 77 patients with community-acquired pleural infection, whereof 63 (82%) represented oral-type pleural infections. Clinical and anamnestic data were systematically collected, and patients were offered a dental assessment by an oral surgeon. Microbial characterizations were done using next-generation sequencing. Obtained bacterial profiles were compared with microbiology data from previous investigations on odontogenic infections, bacteremia after extraction of infected teeth, and community-acquired brain abscesses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From the oral-type pleural infections, we made 267 bacterial identifications representing 89 different species. Streptococcus intermedius and\/or Fusobacterium nucleatum were identified as a dominant component in all infections. We found a high prevalence of dental infections among patients with oral-type pleural infection and demonstrate substantial similarities between the microbiology of such pleural infections and that of odontogenic infections, odontogenic bacteremia, and community-acquired brain abscesses.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Oral-type pleural infection is the most common type of community-acquired pleural infection. Current evidence supports hematogenous seeding of bacteria from a dental focus as the most important underlying etiology. Streptococcus intermedius and Fusobacterium nucleatum most likely represent key pathogens necessary for establishing the infection.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/cid\/ciad378","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T21:01:59Z","timestamp":1687640519000},"page":"1361-1371","source":"Crossref","is-referenced-by-count":41,"title":["Pleural Empyema Caused by Streptococcus intermedius<\/i> and Fusobacterium nucleatum<\/i>: A Distinct Entity of Pleural Infections"],"prefix":"10.1093","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2486-5426","authenticated-orcid":false,"given":"Ruben","family":"Dyrhovden","sequence":"first","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas Mikal","family":"Eagan","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, University of Bergen , Bergen , Norway"},{"name":"Department of Thoracic Medicine, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein","family":"Fl\u00f8tten","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, University of Bergen , Bergen , Norway"},{"name":"Department of Thoracic Medicine, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Siljan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Akershus University Hospital , L\u00f8renskog , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Truls Michael","family":"Leegaard","sequence":"additional","affiliation":[{"name":"Division of Medicine and Laboratory Sciences, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo , Oslo , Norway"},{"name":"Department of Microbiology and Infection Control, Akershus University Hospital , Akershus , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rnar","family":"B\u00f8","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Stavanger University Hospital , Stavanger , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"Fardal","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Stavanger University Hospital , Stavanger , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Gr\u00f8van","sequence":"additional","affiliation":[{"name":"Department of Medicine, Haraldsplass Deaconess Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Kildahl-Andersen","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital , Trondheim , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjersti Wik","family":"Larssen","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital , Trondheim , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rune","family":"Tilseth","sequence":"additional","affiliation":[{"name":"Department of Medicine, F\u00f8rde Central Hospital , F\u00f8rde , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reidar","family":"Hjetland","sequence":"additional","affiliation":[{"name":"Department of Microbiology, F\u00f8rde Central Hospital , F\u00f8rde , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigbj\u00f8rn","family":"L\u00f8es","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Haukeland University Hospital , Bergen , Norway"},{"name":"Faculty of Health Sciences, UiT The Arctic University of Norway , Troms\u00f8 , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frode","family":"Lindemark","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit","family":"Tellevik","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Breistein","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8yvind","family":"Kommedal","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Haukeland University Hospital , Bergen , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"2023111710165079800_ciad378-B1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S2213-2600(15)00185-X","article-title":"Pleural infection: past, present, and future directions","volume":"3","author":"Corcoran","year":"2015","journal-title":"Lancet Respir Med"},{"key":"2023111710165079800_ciad378-B2","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.cmi.2018.11.030","article-title":"The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study","volume":"25","author":"Dyrhovden","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2023111710165079800_ciad378-B3","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00542-2019","article-title":"The microbiology of pleural infection in adults: a systematic review","volume":"54","author":"Hassan","year":"2019","journal-title":"Eur Respir J"},{"key":"2023111710165079800_ciad378-B4","doi-asserted-by":"crossref","first-page":"e294","DOI":"10.1016\/S2666-5247(21)00327-X","article-title":"The bacteriology of pleural infection (TORPIDS): an exploratory metagenomics analysis through next generation sequencing","volume":"3","author":"Kanellakis","year":"2022","journal-title":"Lancet Microbe"},{"key":"2023111710165079800_ciad378-B5","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1164\/rccm.200601-074OC","article-title":"The bacteriology of pleural infection by genetic and standard methods and its mortality significance","volume":"174","author":"Maskell","year":"2006","journal-title":"Am J Resp Crit Care"},{"key":"2023111710165079800_ciad378-B6","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1378\/chest.115.1.178","article-title":"The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study","volume":"115","author":"Marik","year":"1999","journal-title":"Chest"},{"key":"2023111710165079800_ciad378-B7","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s40168-022-01362-4","article-title":"The lower airways microbiota and antimicrobial peptides indicate dysbiosis in sarcoidosis","volume":"10","author":"Knudsen","year":"2022","journal-title":"Microbiome"},{"key":"2023111710165079800_ciad378-B8","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.3390\/microorganisms9061307","article-title":"Microbiome of odontogenic abscesses","volume":"9","author":"B\u00f6ttger","year":"2021","journal-title":"Microorganisms"},{"key":"2023111710165079800_ciad378-B9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/0022034508328124","article-title":"The microbiota of acute apical abscesses","volume":"88","author":"Siqueira","year":"2009","journal-title":"J Dent Res"},{"key":"2023111710165079800_ciad378-B10","doi-asserted-by":"crossref","first-page":"30989","DOI":"10.3402\/jom.v8.30989","article-title":"Oral microbiota species in acute apical endodontic abscesses","volume":"8","author":"George","year":"2016","journal-title":"J Oral Microbiol"},{"key":"2023111710165079800_ciad378-B11","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1128\/JCM.00346-14","article-title":"Massive parallel sequencing provides new perspectives on bacterial brain abscesses","volume":"52","author":"Kommedal","year":"2014","journal-title":"J Clin Microbiol"},{"key":"2023111710165079800_ciad378-B12","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.00598-21","article-title":"Managing contamination and diverse bacterial loads in 16S rRNA deep sequencing of clinical samples: implications of the law of small numbers","volume":"12","author":"Dyrhovden","year":"2021","journal-title":"Mbio"},{"key":"2023111710165079800_ciad378-B13","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.cmi.2020.03.028","article-title":"Molecular diagnosis of polymicrobial brain abscesses with 16S-rDNA-based next-generation sequencing","volume":"27","author":"Stebner","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2023111710165079800_ciad378-B14","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/cid\/cir797","article-title":"Metagenomic analysis of brain abscesses identifies specific bacterial associations","volume":"54","author":"Masalma","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2023111710165079800_ciad378-B15","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1111\/apm.13181","article-title":"Diagnostics with clinical microbiome-based identification of microorganisms in patients with brain abscesses\u2014a prospective cohort study","volume":"129","author":"Hansen","year":"2021","journal-title":"APMIS"},{"key":"2023111710165079800_ciad378-B16","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1128\/CMR.00082-12","article-title":"Microbiology and treatment of acute apical abscesses","volume":"26","author":"Siqueira","year":"2013","journal-title":"Clin Microbiol Rev"},{"key":"2023111710165079800_ciad378-B17","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1038\/ismej.2012.174","article-title":"The subgingival microbiome in health and periodontitis and its relationship with community biomass and inflammation","volume":"7","author":"Abusleme","year":"2013","journal-title":"ISME J"},{"key":"2023111710165079800_ciad378-B18","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1128\/JCM.02004-07","article-title":"Diverse and novel oral bacterial species in blood following dental procedures","volume":"46","author":"Bahrani-Mougeot","year":"2008","journal-title":"J Clin Microbiol"},{"key":"2023111710165079800_ciad378-B19","doi-asserted-by":"crossref","first-page":"3118","DOI":"10.1161\/CIRCULATIONAHA.107.758524","article-title":"Bacteremia associated with toothbrushing and dental extraction","volume":"117","author":"Lockhart","year":"2008","journal-title":"Circulation"},{"key":"2023111710165079800_ciad378-B20","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1007\/s00134-003-1697-z","article-title":"Bacteremia and sepsis due to Prevotella oris from dentoalveolar abscesses","volume":"29","author":"Bein","year":"2003","journal-title":"Intensive Care Med"},{"key":"2023111710165079800_ciad378-B21","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/154405910408300217","article-title":"Bacteremia following surgical dental extraction with an emphasis on anaerobic strains","volume":"83","author":"Rajasuo","year":"2004","journal-title":"J Dent Res"},{"key":"2023111710165079800_ciad378-B22","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1128\/AAC.00056-07","article-title":"Antimicrobial susceptibilities of Peptostreptococcus anaerobius and the newly described Peptostreptococcus stomatis isolated from various human sources","volume":"51","author":"Ko\u0308no\u0308nen","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"2023111710165079800_ciad378-B23","year":"2022"},{"key":"2023111710165079800_ciad378-B24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0061217","article-title":"Phyloseq: an R package for reproducible interactive analysis and graphics of microbiome census data","volume":"8","author":"McMurdie","year":"2013","journal-title":"PLoS One"},{"key":"2023111710165079800_ciad378-B25","author":"Oksanen","year":"2022"},{"key":"2023111710165079800_ciad378-B26","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/2041-210X.12628","article-title":"Ggtree: an r package for visualization and annotation of phylogenetic trees with their covariates and other associated data","volume":"8","author":"Yu","year":"2017","journal-title":"Methods Ecol Evol"},{"key":"2023111710165079800_ciad378-B27","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1093\/bioinformatics\/bty633","article-title":"Ape 5.0: an environment for modern phylogenetics and evolutionary analyses in R","volume":"35","author":"Paradis","year":"2019","journal-title":"Bioinformatics"},{"key":"2023111710165079800_ciad378-B28","doi-asserted-by":"crossref","first-page":"W293","DOI":"10.1093\/nar\/gkab301","article-title":"Interactive Tree Of Life (iTOL) v5: an online tool for phylogenetic tree display and annotation","volume":"49","author":"Letunic","year":"2021","journal-title":"Nucleic Acids Res"},{"key":"2023111710165079800_ciad378-B29","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1046\/j.1365-2591.2001.00419.x","article-title":"Detection of Slackia exigua, Mogibacterium timidum and Eubacterium saphenum from pulpal and periradicular samples using the polymerase chain reaction (PCR) method","volume":"34","author":"Hashimura","year":"2001","journal-title":"Int Endod J"},{"key":"2023111710165079800_ciad378-B30","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1046\/j.1365-2591.2003.00636.x","article-title":"Campylobacter gracilis and Campylobacter rectus in primary endodontic infections","volume":"36","author":"Siqueira","year":"2003","journal-title":"Int Endod J"},{"key":"2023111710165079800_ciad378-B31","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1002\/pmic.201000631","article-title":"Oxidative stress response in the opportunistic oral pathogen Fusobacterium nucleatum","volume":"11","author":"Steeves","year":"2011","journal-title":"Proteomics"},{"key":"2023111710165079800_ciad378-B32","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01062-2022","article-title":"ERS\/ESTS statement on the management of pleural infection in adults","volume":"61","author":"Bedawi","year":"2023","journal-title":"Eur Respir J"},{"key":"2023111710165079800_ciad378-B33","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00541-2019","article-title":"A systematic review of comorbidities and outcomes of adult patients with pleural infection","volume":"54","author":"Cargill","year":"2019","journal-title":"Eur Respir J"},{"key":"2023111710165079800_ciad378-B34","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1136\/thx.2008.105080","article-title":"Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia","volume":"64","author":"Chalmers","year":"2009","journal-title":"Thorax"},{"key":"2023111710165079800_ciad378-B35","first-page":"198","volume-title":"Brain abscess and other focal pyogenic infections of the central nervous system.","author":"Brook","year":"2017","edition":"4th ed."},{"key":"2023111710165079800_ciad378-B36","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.03546-2020","article-title":"Epidemiology of pleural empyema in English hospitals and the impact of influenza","volume":"57","author":"Arnold","year":"2021","journal-title":"Eur Respir J"},{"key":"2023111710165079800_ciad378-B37","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1038\/s41598-022-05723-9","article-title":"Investigating the human jejunal microbiota","volume":"12","author":"Villmones","year":"2022","journal-title":"Sci Rep"},{"key":"2023111710165079800_ciad378-B38","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000312404","article-title":"Etiology and outcome of community-acquired lung abscess","volume":"80","author":"Takayanagi","year":"2010","journal-title":"Respiration"},{"issue":"Suppl 2","key":"2023111710165079800_ciad378-B39","first-page":"229","article-title":"Lung abscess and thoracic empyema: retrospective analysis in an internal medicine department","volume":"24","author":"Monteiro","year":"2011","journal-title":"Acta Medica Port"},{"key":"2023111710165079800_ciad378-B40","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/1749-8090-5-88","article-title":"Lung abscess predicts the surgical outcome in patients with pleural empyema","volume":"5","author":"Huang","year":"2010","journal-title":"J Cardiothorac Surg"},{"key":"2023111710165079800_ciad378-B41","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.crad.2020.12.017","article-title":"CT Appearances of pleural infection: analysis of the second Multi-Centre Intra-pleural Sepsis Trial (MIST 2) cohort","volume":"76","author":"Franklin","year":"2021","journal-title":"Clin Radiol"},{"key":"2023111710165079800_ciad378-B42","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1136\/thoraxjnl-2020-215267","article-title":"Epidemiology and prognostic factors of pleural empyema","volume":"76","author":"Bobbio","year":"2021","journal-title":"Thorax"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciad378\/50915955\/ciad378.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/77\/10\/1361\/53479335\/ciad378.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/77\/10\/1361\/53479335\/ciad378.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T13:31:34Z","timestamp":1700227894000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/77\/10\/1361\/7205386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,22]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,6,22]]},"published-print":{"date-parts":[[2023,11,17]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciad378","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,15]]},"published":{"date-parts":[[2023,6,22]]}}}