Antibiotic resistance in empyema thoracis: clinical outcomes and contributing factors in a tertiary care setting in Pakistan.

Objectives: This study aimed to determine the antibiotic resistance patterns, clinical outcomes, and factors influencing treatment outcomes in patients with empyema thoracis (ET).

Methods: A total of 294 patients with ET (65.9% males, 34.1% females; mean age 47.9 ± 17.1 years) were included. Predisposing factors, comorbidities, microbial pathogens, and antibiotic resistance patterns were analyzed. Clinical improvement and associations with demographic and clinical variables were statistically evaluated.

Results: Pulmonary parenchymal infection (68.2%) was the most common predisposing factor, followed by postoperative empyema (11.2%). Rural residency (64.3%), biomass exposure (71.0%), and non-smoking status (75.2%) were prevalent. Community-acquired empyema was observed in 72.2% of cases, and clinical improvement was achieved in 59.18%. (45 cases), (32 cases), and (23 cases) were the most frequently isolated pathogens. Significant associations were found between no clinical improvement and male gender, rural residency, smoking, biomass exposure, and microorganism presence ( <0.05). Antibiotic susceptibility testing highlighted variable resistance patterns.

Conclusions: ET remains a significant clinical challenge, with community-acquired infections and predominating. Effective antibiotic stewardship and targeted management strategies are essential to improving outcomes, especially in high-risk populations.