{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:53:57Z","timestamp":1777312437833,"version":"3.51.4"},"reference-count":64,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"\n Introduction:<\/jats:bold>\n Empyema, characterized by the accumulation of pus in the pleural space, poses a significant medical challenge with diverse complications. This study aims to provide a comprehensive overview of the epidemiology, microbiological spectrum, management strategies, and outcomes of empyema patients in Qatar.\n <\/jats:p>\n Methods: We conducted a comprehensive review of electronic medical records from all hospitals affiliated with Hamad Medical Corporation, the national healthcare system of Qatar, for patients aged 18 years and older diagnosed with empyema between January 1, 2015, and December 31, 2019.<\/jats:p>\n \n Results:<\/jats:bold>\n Seventy-five empyema cases were reviewed, predominantly male (89.3%) with a mean age of 44 years. Common comorbidities included diabetes mellitus (30.7%) and a history of malignancy (20%). Pleural fluid was universally exudative, with turbidity in (55.4%) and blood staining in (16.9%).\n Streptococcus<\/jats:italic>\n (38.7%) and Gram-negative bacteria (29.3%) were the predominant pathogens. All patients received antibiotics, with chest tube insertion as the primary intervention in 74.6%. Video-Assisted Thoracoscopic Surgery (VATS) was performed in 24% and medical thoracoscopy in 1.3%. The mortality rate was significant at 18.6%. Univariate and multivariate analyses indicated that a prior history of pneumonia (\n P<\/jats:italic>\n = 0.004), pleural effusion\/empyema (\n P<\/jats:italic>\n = 0.024), and malignancy (\n P<\/jats:italic>\n < 0.036) were significant predictors of mortality.\n <\/jats:p>\n \n Conclusion:<\/jats:bold>\n Streptococci were identified as the predominant pathogen in empyema cases in Qatar, with Diabetes Mellitus being the most common comorbidity. Early antibiotic therapy and chest tube insertion were key to effective management, often reducing the need for surgical interventions. Despite this, mortality remains a significant concern.\n <\/jats:p>","DOI":"10.5339\/qmj.2025.110","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T11:30:29Z","timestamp":1765366229000},"source":"Crossref","is-referenced-by-count":0,"title":["Understanding empyema in Qatar: Microbiological profiles, clinical outcomes, and targeted treatment through a retrospective analysis"],"prefix":"10.5339","volume":"2025","author":[{"given":"Theeb Osama","family":"Sulaiman","sequence":"first","affiliation":[{"name":"Department of Chest, Hamad General Hospital, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mousa","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Chest, Hamad General Hospital, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Yaseen","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hamad General Hospital, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansoor","family":"Hameed","sequence":"additional","affiliation":[{"name":"Department of Chest, Hamad General Hospital, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merlin","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Chest, Hamad General Hospital, Doha, Qatar"},{"name":"Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar*Correspondance: Theeb Osama Sulaiman theebpalestine.21@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelnasser","family":"Elzouki","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hamad General Hospital, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"issue":"(1):","key":"B1","series-title":"Proc Am Thorac Soc","first-page":"75\u201380","article-title":"Parapneumonic effusions and empyema","volume":"3","author":"Light\n \nRW","year":"2006;"},{"issue":"(6):","key":"B2","series-title":"Eur Respir J","first-page":"2003546","article-title":"Epidemiology of pleural empyema in English hospitals and the impact of influenza","volume":"57","author":"Arnold\n \nDT","year":"2021"},{"issue":"(7):","key":"B3","series-title":"Am J Respir Crit Care Med","first-page":"817\u201323","article-title":"The bacteriology of pleural infection by genetic and standard methods and its mortality significance","volume":"174","author":"Maskell\n \nNA","year":"2006"},{"issue":"(10):","key":"B4","series-title":"Am J Med","first-page":"877\u201383","article-title":"Thoracic empyema in patients with community-acquired pneumonia","volume":"119","author":"Ahmed\n \nRA","year":"2006"},{"issue":"(3):","key":"B5","series-title":"Hong Kong Med J","first-page":"178\u201386","article-title":"Complicated parapneumonic effusion and empyema thoracis: microbiology and predictors of adverse outcomes","volume":"13","author":"Tsang\n \nKY","year":"2007"},{"issue":"(7):","key":"B6","series-title":"East Mediterr Health J","first-page":"611\u20138","article-title":"Etiology of pleural effusion among adults in the state of Qatar: a l-year hospital-based study","volume":"17","author":"Khan\n \nFY","year":"2011"},{"issue":"(5):","key":"B7","series-title":"Ann Thorac Surg","first-page":"1525\u201331","article-title":"Choice of first intervention is related to outcomes in the management of empyema","volume":"87","author":"Wozniak\n \nCJ","year":"2009"},{"issue":"(4):","key":"B8","series-title":"N Engl J Med","first-page":"243\u201350","article-title":"A prediction rule to identify low-risk patients with community-acquired pneumonia","volume":"336","author":"Fine\n \nMJ","year":"1997"},{"key":"B9","series-title":"In: StatPearls","article-title":"Thoracic empyema","author":"Iguina\n \nMM","year":"2025"},{"issue":"(12):","key":"B10","series-title":"East Afr Med J","first-page":"766\u20139","article-title":"Empyema thoracis in adults in Saudi Arabia","volume":"72","author":"Grillo\n \nIA","year":"1995"},{"issue":"(3):","key":"B11","series-title":"Scand J Infect Dis","first-page":"165\u20139","article-title":"Bacteriological aetiology and antimicrobial treatment of pleural empyema","volume":"43","author":"Meyer\n \nCN","year":"2011"},{"issue":"(8):","key":"B12","series-title":"Rozhl Chir","first-page":"379\u201383","article-title":"Pleural empyema - single center experience","volume":"97","author":"Dole\u017eal\n \nJ","year":"2018"},{"key":"B13","series-title":"Qatar Census December 2020","author":"National Planning Council"},{"issue":"(9):","key":"B14","series-title":"N Engl J Med","first-page":"865\u201374","article-title":"U.K. Controlled trial of intrapleural streptokinase for pleural infection [N Engl J Med. 2005 May;352(20):2146]","volume":"352","author":"Maskell\n \nNA","year":"2005;"},{"issue":"(1):","key":"B15","series-title":"PLoS One","first-page":"e30074","article-title":"Thoracic empyema: a 12-year study from a UK tertiary cardiothoracic referral centre","volume":"7","author":"Marks\n \nDJ","year":"2012;"},{"key":"B16","series-title":"Front Public Health","first-page":"748157","article-title":"Prevalence, awareness, treatment and control of diabetes in India from the Countrywide National NCD Monitoring Survey","volume":"10","author":"Mathur\n \nP","year":"2022"},{"issue":"(8):","key":"B17","series-title":"Clin Microbiol Infect","first-page":"981\u20136","article-title":"The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study","volume":"25","author":"Dyrhovden\n \nR","year":"2019"},{"issue":"(10):","key":"B18","series-title":"BMJ Open","first-page":"e055181","article-title":"Emergency department presentations of alcohol and other substance misuse: first cross-sectional national study in Qatar","volume":"11","author":"Alabdulla\n \nM","year":"2021"},{"issue":"(Suppl 2):","key":"B19","series-title":"Crit Care","first-page":"P43","article-title":"Ten-year exploratory retrospective study on empyema","volume":"12","author":"Marmagkiolis\n \nKM","year":"2008;"},{"issue":"(3):","key":"B20","series-title":"Acta Med Iran","first-page":"203\u20137","article-title":"Management of thoracic empyema: review of 112 cases","volume":"50","author":"Vaziri\n \nM","year":"2012;"},{"issue":"(2):","key":"B21","series-title":"Interact Cardiovasc Thorac Surg","first-page":"171\u20137","article-title":"Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?","volume":"11","author":"Chambers\n \nA","year":"2010"},{"issue":"(4):","key":"B22","series-title":"Ann Afr Surg","first-page":"175\u20139","article-title":"Empyema thoracis-the role of open thoracotomy with decortication in the era of video-assisted thoracoscopic surgery","volume":"19","author":"Sindgikar\n \nV","year":"2022"},{"issue":"(9):","key":"B23","series-title":"South Med J","first-page":"909\u201314","article-title":"Hospital-acquired thoracic empyema in adults: a 5-year study","volume":"102","author":"Chen\n \nW","year":"2009"},{"issue":"(4):","key":"B24","series-title":"QJM","first-page":"285\u20139","article-title":"The clinical course and management of thoracic empyema","volume":"89","author":"Ferguson\n \nAD","year":"1996"},{"issue":"(1):","key":"B25","series-title":"Emerg Infect Dis","first-page":"44\u20138","article-title":"Parapneumonic empyema deaths during past century, Utah","volume":"15","author":"Bender\n \nJM","year":"2009"},{"issue":"(2):","key":"B26","series-title":"Scand J Surg","first-page":"145\u201351","article-title":"Long-term prognosis and causes of death after pleural infections","volume":"107","author":"Khan\n \nJA","year":"2018"},{"issue":"(4):","key":"B27","series-title":"J Formos Med Assoc","first-page":"210\u20138","article-title":"Acute thoracic empyema: clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery","volume":"113","author":"Chen\n \nKC","year":"2014"},{"issue":"(1):","key":"B28","series-title":"BMC Pulm Med","first-page":"365","article-title":"Outcomes of adult empyema thoracis cases managed in a tertiary hospital in Uganda: a retrospective cohort study","volume":"25","author":"Mwesige\n \nM","year":"2025"},{"issue":"(4):","key":"B29","series-title":"Chest","first-page":"848\u201355","article-title":"A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection","volume":"145","author":"Rahman\n \nNM","year":"2014"},{"issue":"(6):","key":"B30","series-title":"Korean J Thorac Cardiovasc Surg","first-page":"392\u20139","article-title":"Predictors of mortality after surgery for empyema thoracis in chronic kidney disease patients","volume":"53","author":"Pulle\n \nMV","year":"2020"},{"issue":"(1):","key":"B31","series-title":"Acta Med Litu","first-page":"160\u20138","article-title":"Prediction of poor outcome using the urea to albumin ratio in thoracic empyema","volume":"31","author":"Dimitrov\n \nE","year":"2024;"},{"issue":"(6):","key":"B32","series-title":"Respir Investig","first-page":"574\u201381","article-title":"Polymicrobial etiology as a prognostic factor for empyema in addition to the renal, age, purulence, infection source, and dietary factors score","volume":"57","author":"Yamazaki\n \nA","year":"2019"},{"issue":"(1):","key":"B1","series-title":"Proc Am Thorac Soc","first-page":"75\u201380","article-title":"Parapneumonic effusions and empyema","volume":"3","author":"Light\n \nRW","year":"2006;"},{"issue":"(6):","key":"B2","series-title":"Eur Respir J","first-page":"2003546","article-title":"Epidemiology of pleural empyema in English hospitals and the impact of influenza","volume":"57","author":"Arnold\n \nDT","year":"2021"},{"issue":"(7):","key":"B3","series-title":"Am J Respir Crit Care Med","first-page":"817\u201323","article-title":"The bacteriology of pleural infection by genetic and standard methods and its mortality significance","volume":"174","author":"Maskell\n \nNA","year":"2006"},{"issue":"(10):","key":"B4","series-title":"Am J Med","first-page":"877\u201383","article-title":"Thoracic empyema in patients with community-acquired pneumonia","volume":"119","author":"Ahmed\n \nRA","year":"2006"},{"issue":"(3):","key":"B5","series-title":"Hong Kong Med J","first-page":"178\u201386","article-title":"Complicated parapneumonic effusion and empyema thoracis: microbiology and predictors of adverse outcomes","volume":"13","author":"Tsang\n \nKY","year":"2007"},{"issue":"(7):","key":"B6","series-title":"East Mediterr Health J","first-page":"611\u20138","article-title":"Etiology of pleural effusion among adults in the state of Qatar: a l-year hospital-based study","volume":"17","author":"Khan\n \nFY","year":"2011"},{"issue":"(5):","key":"B7","series-title":"Ann Thorac Surg","first-page":"1525\u201331","article-title":"Choice of first intervention is related to outcomes in the management of empyema","volume":"87","author":"Wozniak\n \nCJ","year":"2009"},{"issue":"(4):","key":"B8","series-title":"N Engl J Med","first-page":"243\u201350","article-title":"A prediction rule to identify low-risk patients with community-acquired pneumonia","volume":"336","author":"Fine\n \nMJ","year":"1997"},{"key":"B9","series-title":"In: StatPearls","article-title":"Thoracic empyema","author":"Iguina\n \nMM","year":"2025"},{"issue":"(12):","key":"B10","series-title":"East Afr Med J","first-page":"766\u20139","article-title":"Empyema thoracis in adults in Saudi Arabia","volume":"72","author":"Grillo\n \nIA","year":"1995"},{"issue":"(3):","key":"B11","series-title":"Scand J Infect Dis","first-page":"165\u20139","article-title":"Bacteriological aetiology and antimicrobial treatment of pleural empyema","volume":"43","author":"Meyer\n \nCN","year":"2011"},{"issue":"(8):","key":"B12","series-title":"Rozhl Chir","first-page":"379\u201383","article-title":"Pleural empyema - single center experience","volume":"97","author":"Dole\u017eal\n \nJ","year":"2018"},{"key":"B13","series-title":"Qatar Census December 2020","author":"National Planning Council"},{"issue":"(9):","key":"B14","series-title":"N Engl J Med","first-page":"865\u201374","article-title":"U.K. Controlled trial of intrapleural streptokinase for pleural infection [N Engl J Med. 2005 May;352(20):2146]","volume":"352","author":"Maskell\n \nNA","year":"2005;"},{"issue":"(1):","key":"B15","series-title":"PLoS One","first-page":"e30074","article-title":"Thoracic empyema: a 12-year study from a UK tertiary cardiothoracic referral centre","volume":"7","author":"Marks\n \nDJ","year":"2012;"},{"key":"B16","series-title":"Front Public Health","first-page":"748157","article-title":"Prevalence, awareness, treatment and control of diabetes in India from the Countrywide National NCD Monitoring Survey","volume":"10","author":"Mathur\n \nP","year":"2022"},{"issue":"(8):","key":"B17","series-title":"Clin Microbiol Infect","first-page":"981\u20136","article-title":"The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study","volume":"25","author":"Dyrhovden\n \nR","year":"2019"},{"issue":"(10):","key":"B18","series-title":"BMJ Open","first-page":"e055181","article-title":"Emergency department presentations of alcohol and other substance misuse: first cross-sectional national study in Qatar","volume":"11","author":"Alabdulla\n \nM","year":"2021"},{"issue":"(Suppl 2):","key":"B19","series-title":"Crit Care","first-page":"P43","article-title":"Ten-year exploratory retrospective study on empyema","volume":"12","author":"Marmagkiolis\n \nKM","year":"2008;"},{"issue":"(3):","key":"B20","series-title":"Acta Med Iran","first-page":"203\u20137","article-title":"Management of thoracic empyema: review of 112 cases","volume":"50","author":"Vaziri\n \nM","year":"2012;"},{"issue":"(2):","key":"B21","series-title":"Interact Cardiovasc Thorac Surg","first-page":"171\u20137","article-title":"Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?","volume":"11","author":"Chambers\n \nA","year":"2010"},{"issue":"(4):","key":"B22","series-title":"Ann Afr Surg","first-page":"175\u20139","article-title":"Empyema thoracis-the role of open thoracotomy with decortication in the era of video-assisted thoracoscopic surgery","volume":"19","author":"Sindgikar\n \nV","year":"2022"},{"issue":"(9):","key":"B23","series-title":"South Med J","first-page":"909\u201314","article-title":"Hospital-acquired thoracic empyema in adults: a 5-year study","volume":"102","author":"Chen\n \nW","year":"2009"},{"issue":"(4):","key":"B24","series-title":"QJM","first-page":"285\u20139","article-title":"The clinical course and management of thoracic empyema","volume":"89","author":"Ferguson\n \nAD","year":"1996"},{"issue":"(1):","key":"B25","series-title":"Emerg Infect Dis","first-page":"44\u20138","article-title":"Parapneumonic empyema deaths during past century, Utah","volume":"15","author":"Bender\n \nJM","year":"2009"},{"issue":"(2):","key":"B26","series-title":"Scand J Surg","first-page":"145\u201351","article-title":"Long-term prognosis and causes of death after pleural infections","volume":"107","author":"Khan\n \nJA","year":"2018"},{"issue":"(4):","key":"B27","series-title":"J Formos Med Assoc","first-page":"210\u20138","article-title":"Acute thoracic empyema: clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery","volume":"113","author":"Chen\n \nKC","year":"2014"},{"issue":"(1):","key":"B28","series-title":"BMC Pulm Med","first-page":"365","article-title":"Outcomes of adult empyema thoracis cases managed in a tertiary hospital in Uganda: a retrospective cohort study","volume":"25","author":"Mwesige\n \nM","year":"2025"},{"issue":"(4):","key":"B29","series-title":"Chest","first-page":"848\u201355","article-title":"A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection","volume":"145","author":"Rahman\n \nNM","year":"2014"},{"issue":"(6):","key":"B30","series-title":"Korean J Thorac Cardiovasc Surg","first-page":"392\u20139","article-title":"Predictors of mortality after surgery for empyema thoracis in chronic kidney disease patients","volume":"53","author":"Pulle\n \nMV","year":"2020"},{"issue":"(1):","key":"B31","series-title":"Acta Med Litu","first-page":"160\u20138","article-title":"Prediction of poor outcome using the urea to albumin ratio in thoracic empyema","volume":"31","author":"Dimitrov\n \nE","year":"2024;"},{"issue":"(6):","key":"B32","series-title":"Respir Investig","first-page":"574\u201381","article-title":"Polymicrobial etiology as a prognostic factor for empyema in addition to the renal, age, purulence, infection source, and dietary factors score","volume":"57","author":"Yamazaki\n \nA","year":"2019"}],"container-title":["Qatar Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2025\/4\/article-110.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2025\/4\/article-110.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.qscience.com\/downloadpdf\/journals\/qmj\/2025\/4\/article-110.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:16:29Z","timestamp":1777310189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.qscience.com\/view\/journals\/qmj\/2025\/4\/article-110.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":64,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.5339\/qmj.2025.110","relation":{},"ISSN":["2227-0426"],"issn-type":[{"value":"2227-0426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]}}}