Clinical characteristics and prognosis of nontuberculous mycobacterial empyema: Comparison with nontuberculous mycobacterial disease without empyema and nonnontuberculous mycobacterial empyema

Clinical characteristics and prognosis of nontuberculous mycobacterial empyema: Comparison with nontuberculous mycobacterial disease without empyema and nonnontuberculous mycobacterial empyema | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical characteristics and prognosis of nontuberculous mycobacterial empyema: Comparison with nontuberculous mycobacterial disease without empyema and nonnontuberculous mycobacterial empyema Hitoshi Suzuki, Daisuke Ito, Mari Shinoda, Shin Shomura, Makoto Tanabe, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4608859/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives The purpose of this study was to clarify the clinical characteristics and report the efficacy of our therapeutic strategy for treating nontuberculous mycobacterial empyema (NTM empyema). Methods The medical records of 302 patients with pulmonary nontuberculous mycobacterial (NTM) disease were retrospectively reviewed, and 364 patients with acute empyema were prospectively reviewed to select patients complicated by NTM empyema from September 2014 to December 2022 in our hospital. NTM empyema was defined as a positive NTM culture of pleural effusion samples. Results Among 304 patients with pulmonary NTM, 13 had NTM empyema (4.3%). The mean age was 78 years, the mean performance status (PS) was 3, and 9 patients (69.2%) had pneumothorax. Age, male sex, comorbidities, fibrocavitary forms, pneumothorax, and lung cavitation were more common in patients with NTM empyema than in patients without NTM disease. Age, PS, comorbidity rate, pneumothorax incidence, and mortality rate were higher in the NTM empyema group than in the non-NTM empyema group. Similarly, the percentage of patients who were cured of pneumothorax without surgical intervention was significantly lower in the NTM empyema group (15.4%) than in the non-NTM empyema group (78.0%). Conclusions This study revealed that NTM empyema has a poor prognosis and is difficult to treat with medication alone. Fistulous NTM empyema should also be added to the indications for surgical intervention. Early surgical intervention should be considered for selected patients with NTM empyema. Nontuberculous mycobacteriosis Pleural empyema Prospective study Pneumothorax Introduction Nontuberculous mycobacterial (NTM) infection can cause chronic and slowly progressive pulmonary disease. The increasing prevalence of pulmonary infections caused by NTM pathogens is an emerging public health concern worldwide [1.2]. NTM empyema is rarer than tuberculosis [ 3.4]. Only a few studies in the literature [5.6] have reported the clinical characteristics, pathogenesis, and prognosis of NTM infection. In addition, the clinical characteristics and treatment outcomes of patients with NTM empyema were compared with those of patients with NTM disease without empyema and patients with non-NTM empyema in this study. The highlight of this study was showing the treatment outcome of the patients with NTM empyema. Patients and methods We retrospectively reviewed the medical records of 302 patients at our institution with pulmonary NTM disease meeting the 2020 ATS/ERS/ESCMID/IDSA [1] criteria and prospectively reviewed 364 patients with empyema between September 2014 and December 2022 (IRB No. 2014-0021/Registration date 14/9/2014). Empyema was diagnosed if septations or loculations were identified in the pleural space on computed tomography scans, if gross pus or organisms were detected by Gram staining or culture, or if biochemical methods were positive. The study population with NTM empyema was selected in addition to those with positive cultures of NTM from pleural effusion. Computed tomography (CT) images were evaluated for cavitary lesions and radiological patterns, and all NTM patients were categorized as having the nodular/-bronchiectatic or fibrocavitary form. Therapeutic strategies for acute empyema Early surgical intervention is recommended for 1. Multiloculated empyema, 2. Methicillin- r esistant Staphylococcus aureus empyema, or 3. no response to antibiotics treatment within three days. Exceptions: grade 4 PS as described previously [7]. We shared the results of the report, and treatment plans and chest drainage procedures were subsequently performed by pulmonologists and thoracic surgeons at our hospital and surrounding facilities. Multiple chest tubes were frequently inserted. Penicillins combined with β-lactamase inhibitors were used according to the British Thoracic Society guidelines [5]. Operative technique: An endoscope was inserted at the middle aspect of the 7th intercostal space for inspection of the pleural cavity. A transverse skin incision (approximately 5 cm) was made laterally at the largest empyema cavity level. The first step consisted of complete evacuation of the fluid component of the empyema by suction, disruption of fibrinous pleural septations, and gentle removal of minor adhesions until the empyema cavity became a single space. The next step included repeated pleural lavage with hydrogen peroxide and normal saline until the cavity was clean. Finally, 28-Fr chest tubes were placed at the apical position and on the diaphragm. A 6-Fr chest tube was inserted for irrigation. Antibiotic treatment was terminated when the serum C-reactive protein (CRP) concentration decreased to less than 5 mg/dl, and the patient was discharged 2 days later [7]. Statistical analysis The analyses were performed using the StatMate III statistical software (ATMS Co., Ltd., Tokyo, Japan). Patient characteristics were compared using the chi-square test or Fisher’s exact test for categorical data and t tests for continuous data. A two-sided p value < 0.05 was considered to indicate statistical significance. Results Clinical characteristics of patients with NTM empyema and NTM disease without empyema The clinical characteristics of patients with NTM empyema and NTM disease without empyema are shown in Table 1. Among those with NTM disease without empyema, 8.7% were immunocompromised (23 were steroid users, 2 were immunosuppressant users, and 0 used anticancer drugs). Among those with NTM empyema, 38.5% were immunocompromised (5 were steroid users, 0 were immunosuppressant users, and 0 were anticancer drug users). Among those with NTM disease without empyema, 68.2% were female, and 21.5% had the fibrocavitary form. In both sexes of patients with NTM disease without empyema, the frequency of the fibrocavitary form was lower than that of the nodular/-bronchiectatic form. Thirty-seven percent of males and 14.2% of females with NTM disease without empyema had the fibrocavitary form. This finding indicated that the frequency of the fibrocavitary form was significantly higher in males than in females (P < 0.001). Patients with NTM empyema were significantly older, more likely to have poorer PS, be male, and have a higher Charlson Comorbidity Index (CCI). Patients with NTM empyema were also more likely to be immunocompromised, have the fibrocavitary form, pneumothorax, lung abscess, and lung cavitation than were the patients with NTM disease without empyema, but no significant difference in the distribution of pathogens was observed between the two groups. Clinical characteristics and outcomes of patients with NTM empyema and non-NTM empyema The clinical characteristics and outcomes of patients with NTM empyema and non-NTM empyema are shown in Table 2. Among those with non-NTM empyema, 11.6% were immunocompromised (11 were steroid users, 19 were immunosuppressant users, and 11 were anticancer drug users). Compared with non-NTM empyema patients, NTM empyema patients were significantly older, had poorer performance status (PS), higher CCI, and higher incidences of immunocompromise, pneumothorax, lung abscess, and lung cavitation. Other factors did not significantly differ between the two groups. The serum white blood cell (WBC) count was higher in the non-NTM empyema group than in the NTM empyema group, but there was no significant difference in the serum CRP level. According to the results of the pleural fluid analysis, the adenosine deaminase (ADA) level and the percentage of lymphocytes were higher in patients with NTM empyema than in patients without NTM empyema. For treatment options, the percentage of patients who were cured of pneumothorax without surgical intervention differed significantly. In terms of outcomes, patients with NTM empyema had significantly higher rates of complications, recurrence, and mortality than did patients without NTM empyema. In addition, there was a statistically significant difference between the mortality rate for fistulous NTM empyema patients and that for fistulous non-NTM empyema patients. Clinical characteristics of surgically treated patients and nonsurgically treated patients with NTM empyema The clinical characteristics of surgically treated patients and nonsurgically treated patients with NTM empyema are shown in Table 3. The incidence of lung cavitation at admission differed significantly between surgically treated patients and nonsurgically treated patients. The mortality rate in nonsurgically treated patients was 50%, while that in surgically treated patients was 22%, however, these two groups were not significantly different. Clinical course of the 13 patients with NTM empyema. The clinical course of the 13 NTM empyema patients is shown in Table 4. Pulmonary NTM infection was diagnosed simultaneously with empyema in 5 of 13 patients (38%). Preexisting pulmonary NTM infections were not treated with chemotherapy in 3 of 8 patients (36%). After the diagnosis of NTM empyema, 10 patients (77%) were treated with 1-3 antimycobacterial medications. Four (30.8%) patients had abscess lesions, and two patients died (50.0%). Nine (69.2%) patients had cavity lesions, and four patients died (44.4%). All patients who died had pneumothorax. All NTM empyema patients who underwent nonsurgical treatment had uniloculated empyema, and they showed some response to antibiotics or drainage treatment within three days. Two patients were cured without surgical treatment, but two patients died of bilateral pneumonia without surgical treatment. Concerning the surgical treatment for NTM empyema, there was no open window thoracotomy. Surgical intervention for a patient with a PS grade of 4 is contraindicated to our therapeutic strategy for acute empyema. However, surgical intervention was performed in one patient with a grade 4 PS because fistulous empyema was uncontrollable despite drainage and chemotherapy for more than 30 days, and she died 6 days after the operation. A 78-year-old male underwent right upper lobectomy because of a large lung cavity and abscess and died of acute exacerbation of interstitial pneumonia 10 days after the operation. Discussion NTM empyema is a rare condition that has been reported in case reports [8] and retrospective studies [5,6]. To our knowledge, the present study is the first prospective study of NTM empyema to date. Previous studies [9.10] reported that the frequency of pleural effusion in patients with pulmonary NTM was 1.4–3.4%. In our study, 4.3% of patients with pulmonary NTM infection developed empyema with NTM infection isolated from pleural effusion. The most common pathogen causing pleuritis was M. avium , followed by M. kansasii and M. intracellulare according to previous reports [11]. Previous reports [5,6,10] revealed that 40–70% of patients with NTM pleuritis were complicated by pneumothorax, and the mechanism of NTM pleuritis was primarily suspected to be the perforation of pulmonary NTM disease or the spread of inflammation to the pleura [5,6,10,12]. Our study revealed that NTM empyema patients had significantly higher incidences of pneumothorax, lung abscess and lung cavitation than did non-NTM empyema patients. The percentage of patients with NTM empyema who were cured of pneumothorax without surgical intervention was significantly lower (15.4%) than that of patients with non-NTM empyema (78.0%). This result may support the idea that NTM empyema can develop through leakage or perforation without empyema, and that bronchopleural fistulas are more common in NTM empyema. Sugiura et al. [13] reported that the mortality rate was 3.8% for nonfistulous empyema and 44.4% for fistulous empyema. In our study, the mortality rate was 0% for nonfistulous NTM empyema, but the mortality rate was 44.4% for fistulous NTM empyema, although the mortality rate was 12.0% for fistulous non-NTM empyema. Our study revealed that NTM empyema patients had a poorer prognosis than did non-NTM empyema patients, and the causative factors might be older age, poorer PS, and higher incidences of lung cavitation, lung abscess and pneumothorax. However, there was no significant difference in the mortality rate between surgically treated patients with NTM empyema and patients without NTM empyema. Therefore, early surgical intervention should also be considered for patients with fistulous NTM empyema. In a previous study [7], researchers suggested that reducing the time from hospitalization at their hospital to surgical intervention reduced the mortality rate. We recommend early surgical intervention for fistulous NTM empyema patients in addition to our 3 applied procedures. We believe that the appropriate timing for early surgical intervention should be within 3 days of admission to our hospital according to our therapeutic strategy for acute empyema. Previous reports [5,6,10,12,14] revealed that the outcome of treatment for NTM empyema appears to be worse than that for NTM disease without empyema, and the hospital mortality rate is 25–29% [12,14]. The authors also emphasized the importance of immediate therapy, especially drainage and surgical intervention, using a multidisciplinary approach for treating NTM empyema. In this study, the hospital mortality rate was 30.8% (4 of 13 patients), which was comparable to or slightly worse than that in previous reports [12,14], even though our patients were older and had a worse PS. Limitations This study has several limitations. First, this study involved a prospective analysis of all empyema patients from a single institution, but 53.8% of NTM empyema patients and 46.2% of non-NTM empyema patients were transferred from surrounding hospitals due to failed therapy before they were hospitalized at our hospital. Therefore, selection bias was inevitable. Second, because NTM disease without empyema was confirmed in patients from a single institution, these patients might not be representative of national populations. Finally, since NTM empyema is a rare condition, the number of patients examined in our study was small. The size of the sample of patients with NTM empyema was much smaller than that of patients without NTM empyema, and the statistical analysis may not be valid. However, additional large sample studies are needed to confirm our results. Conclusion To our knowledge, the present study is the first prospective study of NTM empyema to date. This study revealed that NTM empyema has a poor prognosis and is difficult to treat with medication alone. Fistulous NTM empyema should also be added to the indications for surgical intervention. Early surgical intervention should be considered for select patients with NTM empyema. Abbreviations M Mycobacterium NTM Nontuberculous mycobacteria PS Performance Status Declarations English proofreading: Springer Nature Author Services Author contributions HS contributed to the data collection, analysis, and interpretation and wrote the initial paper. DI, MS and SS contributed to the data analysis and interpretation and drafted and edited the article. All authors approved the final manuscript. Funding The study was self-funded by the authors. Data availability Data generated in this study are available from the corresponding author upon reasonable request with a completed Materials Transfer Agreement, excluding the materials including personally identifiable information. Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Institutional Ethical Committee of Mie Prefectural General Medical Center, Japan. Written informed consent was obtained from all participants who voluntarily agreed to participate in the study after the research procedure and objectives of the study were explained in simple, clear language. Participants were reassured that the data collected would be confidential and would be used for research purposes only. It was clearly explained that participation in this study was voluntary, and the participant had the right to withdraw at any time without any deprivation. Consent to publication Not applicable. Competing interest s The authors have no competing interests. References Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ Jr, Andrejak C et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020;71:905-13. Izumi K, Morimoto K, Hasegawa N, Uchimura K, Kawatsu L, Ato M, et al. Epidemiology of Adults and Children Treated for Nontuberculous Mycobacterial Pulmonary Disease in Japan. Ann Am Thorac Soc. 2019;16:341-7. Wen P, Wei M, Han C, He Y, Wang MS. Risk factors for tuberculous empyema in pleural tuberculosis patients. Sci Rep. 2019;9:19569. Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998;158:2017-21. Wen P, Wei M, Xu YR, Dong L. Clinical Relevance and Characteristics of Nontuberculous Mycobacterial Pleuritis. Jpn J Infect Dis. 2020;73:282-7. Yagi K, Ito A, Fujiwara K, Morino E, Hase I, Nakano Y et al. Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis: A Multicenter Retrospective Study.Ann Am Thorac Soc. 2021;18:1490-7. Suzuki H, Shomura S, Sawada Y, Shimamoto A, Kondo C, Takao M et al. Therapeutic strategy for acute pleural empyema: comparison between retrospective study and prospective study. Gen Thorac Cardiovasc Surg. 2019;67:1048-1055. Anjum S, Tahir R, Pathan SA. Nontuberculous mycobacterial infection presenting as empyema and life threatening pneumothorax: A challenging situation in the emergency department. Qatar Med J. 2015:8. Kobashi Y, Mouri K, Obase Y, Kato S, Oka M. Clinical analysis of patients with pulmonary nontuberculous mycobacterial disease complicated by pneumothorax. Intern Med 2013;52: 2511-5. Ando T, Kawashima M, Matsui H, Takeda K, Sato R, Ohshima N et al. Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis. Respiration. 2018;96:507-13. Ueyama M, Asakura T, Morimoto K, Namkoong H, Matsuda S, Osawa T et al.Pneumothorax associated with nontuberculous mycobacteria: A retrospective study of 69 patients. Medicine 2016;95(29):e4246. Naito M, Maekura T, Kurahara Y, Tahara M, Ikegami N, Kimura Y et al. Clinical Features of Nontuberculous Mycobacterial Pleurisy: A Review of 12 Cases. Intern Med. 2018;57:13-6. Sugiura Y, Nakamura M, Fujimoto H, Ochiai H, Ohkubo Y, Fusegawa H et al. An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula. Gen Thorac Cardiovasc Surg. 2023;71:657-64. Park S, Jo KW, Lee SD, Kim WS, Shim TS. Clinical characteristics and treatment outcomes of pleural effusions in patients with nontuberculous mycobacterial disease. Respir Med. 2017:133:36-41. Tables Table 1 The clinical characteristics of patients with NTM empyema and NTM disease without empyema. Valuables Age (years) Gender (male/female) CCI Performance Status (PS) Other lung disease, % Immunocompromised patients, % BMI Radiological findings Nodular/- bronchiectatic form Gender (male/female) Fibrocavitary form Gender (male/female) Pneumothorax, % lung abscess, % lung cavitation, % Pathogens M. avium M. intracellulare M. kansasii M. abscessus Others NTM empyema (n = 13) 78 (50-91 ) 8/5 6 (2-14) 3 (0-4) 6 (46.2) 5 (38.5) 18.5 (11.5-25.3) 5 (38.5) 3/2 8 (61.5) 5/3 9 (69.2) 4 (30.8) 9 (69.2) 9 (69.2) 2 (15.4) 0 ( 0.0) 2 (15.4) 0 ( 0.0) NTM disease without empyema (n = 289) 68 (26-96) 92/197 4 (0-10) 0 (0-3) 72 (24.9) 25 ( 8.7) 19.5 (10.4-33.8) 227 (78.5) 58/169 62 (21.5) 34/28 0 ( 0.0) 0 ( 0.0) 76 (26.3) 191 (66.1) 61 (21.1) 17 ( 5.9) 9 ( 3.1) 11 ( 3.8) p-value < 0.01 < 0.05 < 0.01 < 0.001 0.09 < 0.01 0.21 < 0.001 0.08 < 0.001 0.05 < 0.001 < 0.001 < 0.001 0.34 Values are number of patients (%), median or range. NTM , nontuberculous mycobacteria; M., Mycobacterium; CCI, Charlson Comorbidity Index Table 2 Clinical characteristics and outcomes of patients with NTM empyema and non-NTM empyema Valuables Age (years) Gender (male/female) CCI Performance Status (PS) Past history of NTM, % Other lung disease, % Immunocompromised patients, % Serum WBC (/ml) Serum CRP (mg/dl) Pleural fluid analysis pH LDH (IU/L) Total protein (g/dl) Glucose (mg/dl) ADA (U/L) WBC (/ml) Neutrophil, % Lymphocyte, % Pneumothorax, % Mortality, % Cured without operation, % Multiloculated empyema, % lung abscess, % lung cavitation, % Drainage, % Surgical treatment, % Drain retention days Antibiotic administration days Hospitalization days Complication, % Recurrence, % Mortality, % NTM empyema (n = 13) 78 ( 50-91 ) 8/5 6 (2-14) 3 ( 0-4 ) 8 (61.5) 6 (46.2) 5 (38.5) 10800 ( 4100-34800 ) 19.9 ( 5.50-30.13 ) 7.295 ( 6.545-7.766 ) 1432 ( 254-38120 ) 4.3 ( 3.1-5.0 ) 57 ( 0-128 ) 80.6 (16-182) 19400 (4770-211296) 64.1 (14.5-82.1) 26.3 (0.1-80.7) 9 (69.2) 4 (44.4) 2 (15.4) 4 (30.8) 4 (30.8) 9 (69.2) 10 (76.9) 9 (69.2) 9.5 (8-27) 13 (3-31) 23 (11-65) 8 (61.5) 1 ( 7.7) 4 (30.1) non-NTM empyema (n = 351) 72 (15-93) 282/69 5 (0-14) 1 (0-4) 7 ( 2.0) 83 (23.6) 41 (11.6) 14400(2900-57500) 18.5(4.09-54.40) 7.224 (6.000-7.766) 1067 (25-73200) 4.6 (0.6-7.5) 48 (0-547) 29.4 (3.3-440) 9400 (171-513372) 78.2 (2-98) 8.2 (0-90) 50 (14.2) 6 (12.0) 39 (78.0) 50 (14.2) 21 ( 6.0) 135 (38.4) 314 (89.5) 151 (43.0) 11 (2-74) 14 (3-123) 20 (3-256) 56 (16.0) 3 ( 0.9) 38 (10.8) p-value < 0.01 0.10 < 0.01 < 0.01 < 0.001 0.06 < 0.01 < 0.01 0.24 0.31 0.58 0.99 0.69 < 0.05 0.07 0.16 < 0.05 < 0.001 < 0.05 < 0.001 0.10 < 0.001 < 0.05 0.33 0.06 0.61 0.95 0.86 < 0.001 < 0.05 < 0.05 Values are number of patients (%), median or range. NTM, nontuberculous mycobacteria; CCI, Charlson Comorbidity Index ; pH, power of hydrogen; WBC, white blood cells; CRP, C-reactive protein; LDH, Lactate Dehydrogenase Table 3 Clinical characteristics of surgically treated patients and nonsurgically treated patients with NTME Valuables Age (years) Gender (male/female) CCI Performance Status (PS) Other lung disease, % Immunocompromised patients, % Serum WBC (/ml) Serum CRP(mg/dl) Time from onset to hospitalization at our hospital (days) Pleural fluid analysis pH LDH (IU/L) Total protein (g/dl) Glucose (mg/dl) ADA (U/L) WBC (/ml) Neutrophil, % Lymphocyte, % Pneumothorax, % Mortality, % Multiloculated empyema, % lung abscess, % lung cavitation, % Antibiotic administration days Hospitalization days Complication, % Mortality, % surgically treated with NTME (n = 9) 78 ( 50-91 ) 5/4 6 (2-12) 2 ( 0-4 ) 3 (33.3) 3 (33.3) 9900 ( 4100-34800 ) 22.8 (5.50-30.13 ) 7 (4-30) 7.396 ( 6.545-7.766 ) 2187 ( 254-38120 ) 4.5 ( 3.1-5.0 ) 54 ( 0-107 ) 99.7 (20.2-168) 2840 (470-211296) 72.2 (14.5-82.1) 24.5 (0.1-80.7) 7 (77.8) 2 (28.6) 4 (44.4) 2 (22.2) 8 (88.9) 8 (3-54) 23 (12-65) 5 (55.6) 2 (22.2) nonsurgically treated with NTME (n = 4) 76 (60-82) 3/1 9 (6-14) 3 (3) 3 (75.0) 2 (50.0) 11050(9700-15300) 23.5 (10.4-22.4) 5 (0-15) 7.123 (6.894-7.238) 1382 (337-2561) 4.0 (3.4-4.6) 94 (32-124) 44.7 (16-80.6) 1380(830-24900) 49.4 (40.5-87.9) 32.5 (5-43.9) 2 (50.0) 2 (100) 0 (0.0) 1 (25.0) 1 (25.0) 24 (11-31) 18 (6-52) 2 (50.0) 2 (50.0) p-value 0.76 0.49 0.09 0.07 0.43 0.96 0.72 0.87 0.30 0.25 0.27 0.52 0.16 0.05 0.40 0.74 0.35 0.35 0.17 0.11 0.80 < 0.05 0.18 0.47 0.66 0.35 Values are number of patients (%), median or range. NTM, nontuberculous mycobacteria; NTME, NTM empyema; CCI, Charlson Comorbidity Index; pH, power of hydrogen; WBC, white blood cells; CRP, C-reactive protein; LDH, Lactate Dehydrogenase, Table 5 Clinical course of the 13 patients with NTM empyema. Age(years) Sex 82, male 79, male 50, male 77, female 91, male 68, female 68, male 71, female 82, male 78, male 60, male 88, female 86, female Time from lung NTM to empyema 3 months simultaneous simultaneous 10 years 1 years 3 years simultaneous 4 months simultaneous simultaneous 15 years 7 years 4 years Pathogens M. avium M. intracellulare M. avium M. avium M. abscessus M. avium M. avium M. avium M. avium M. intracellulare M. avium M. abscessus M. avium Chemo-therapy before empyema (-) (-) (-) (-) (-) (+) (-) (-) (-) (-) (+) (+) (-) CT findings NB NB FC NB FC FC FC NB NB FC FC FC FC Pneumo-thorax (+) (-) (+) (+) (+) (+) (-) (-) (-) (+) (+) (+) (+) Lung abscess (-) (-) (+) (-) (-) (-) (+) (-) (+) (+) (-) (-) (-) Lung cavitation (-) (-) (+) (+) (+) (+) (+) (-) (-) (+) (+) (+) (+) PS 3 1 0 2 3 4 3 3 3 1 3 2 2 Chemo-therapy after empyema (-) (-) (+) (-) (+) (+) (+) (+) (+) (+) (+) (+) (+) Drainage (+) (+) (+) (+) (+) (+) (+) (-) (-) (+) (-) (+) (+) Surgical treatment (-) (+) (+) (+) (+) (+) (+), S (-) (-) (+), L (-) (+) (+) hospital mortality (+) (-) (-) (-) (-) (+) (-) (-) (-) (+) (+) (-) (-) M, mycobacterium ; NB, nodular/-bronchiectatic form; FC, fibrocavitary form; PS, Performance status; S, Segmentectomy; L, Lobectomy Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4608859","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":329958152,"identity":"6e89256d-8f78-4c92-b5da-11664ae98c10","order_by":0,"name":"Hitoshi Suzuki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIie3RMQrCMBSA4SeCLpU6RgR7hRZBEXqYF4R0cZaOBaUuHqCeQxDHSMEp0LVjRXByqIs4mg6lW5pRMP8QQuEjLymAyfSDuQDIMfQtG6BXf8Q2cuOFYJNRpE8698ttm05d3hB1cztFTiNGj/nyUZQhOHLCR6Eii4RJcvbpKWdzLxHgHSIIXOVguSWJYJLgbDyIAeWEjChJlpWcxik9JsFbk3DEikxdstI9JZcE5SMT8VyPEkG8w6btLhlfvj7Vr9wFJ1KGvmP396xQkaYhVqscqWsxPQE2r3f9qyYxmUymP+kLLcJTlAH1PoAAAAAASUVORK5CYII=","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Hitoshi","middleName":"","lastName":"Suzuki","suffix":""},{"id":329958153,"identity":"6c84b5f4-8c55-4468-a785-79c3f7ad331d","order_by":1,"name":"Daisuke Ito","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Daisuke","middleName":"","lastName":"Ito","suffix":""},{"id":329958154,"identity":"ac2f87ae-782c-46c2-9e64-89ecaa024d17","order_by":2,"name":"Mari Shinoda","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Mari","middleName":"","lastName":"Shinoda","suffix":""},{"id":329958155,"identity":"c4f0ee35-c798-48ff-aec2-1103edc00bd4","order_by":3,"name":"Shin Shomura","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Shin","middleName":"","lastName":"Shomura","suffix":""},{"id":329958156,"identity":"93e882df-f9ff-4b2c-bd0c-3bc21c35b8fb","order_by":4,"name":"Makoto Tanabe","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Makoto","middleName":"","lastName":"Tanabe","suffix":""},{"id":329958157,"identity":"3dc99f0e-81d5-4371-b2b9-e6dd745fb130","order_by":5,"name":"Yasuhiro Sawada","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yasuhiro","middleName":"","lastName":"Sawada","suffix":""},{"id":329958158,"identity":"a1165039-6ace-4f2d-b485-fa4631b78ac8","order_by":6,"name":"Kentaro Inoue","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kentaro","middleName":"","lastName":"Inoue","suffix":""},{"id":329958159,"identity":"58b86c0b-837b-4cb7-b355-67978902cf33","order_by":7,"name":"Akira Shimamoto","email":"","orcid":"","institution":"Mie University","correspondingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Shimamoto","suffix":""},{"id":329958161,"identity":"c29d9aaa-39b6-4d84-a412-09155ac072b2","order_by":8,"name":"Hideto Shimpo","email":"","orcid":"","institution":"Mie Prefectural General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Hideto","middleName":"","lastName":"Shimpo","suffix":""}],"badges":[],"createdAt":"2024-06-20 03:31:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4608859/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4608859/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64659811,"identity":"3612f133-128b-4b07-9cc8-ddc4f85e513f","added_by":"auto","created_at":"2024-09-17 07:39:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":615916,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4608859/v1/7a467e46-b811-448e-ae19-8981486ca4df.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical characteristics and prognosis of nontuberculous mycobacterial empyema: Comparison with nontuberculous mycobacterial disease without empyema and nonnontuberculous mycobacterial empyema","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNontuberculous mycobacterial (NTM) infection can cause chronic and slowly progressive pulmonary disease. The increasing prevalence of pulmonary infections caused by NTM pathogens is an emerging public health concern worldwide [1.2]. NTM empyema is rarer than tuberculosis \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[\u003c/span\u003e3.4]. Only a few studies in the literature [5.6] have reported the clinical characteristics, pathogenesis, and prognosis of NTM infection. In addition, the clinical characteristics and treatment outcomes of patients with NTM empyema were compared with those of patients with NTM disease without empyema and patients with non-NTM empyema in this study. The highlight of this study was showing the treatment outcome of the patients with NTM empyema.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eWe retrospectively reviewed the medical records of 302 patients at our institution with pulmonary NTM disease meeting the 2020 ATS/ERS/ESCMID/IDSA [1] criteria and prospectively reviewed 364 patients with empyema between September 2014 and December 2022 (IRB No. 2014-0021/Registration date 14/9/2014). Empyema was diagnosed if septations or loculations were identified in the pleural space on computed tomography scans, if gross pus or organisms were detected by Gram staining or culture, or if biochemical methods were positive. The study population with NTM empyema was selected in addition to those with positive cultures of NTM from pleural effusion. Computed tomography (CT) images were evaluated for cavitary lesions and radiological patterns, and all NTM patients were categorized as having the nodular/-bronchiectatic or fibrocavitary form.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eTherapeutic strategies for acute empyema\u003c/h2\u003e \u003cp\u003eEarly surgical intervention is recommended for 1. Multiloculated empyema, 2. Methicillin-\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003er\u003c/span\u003eesistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e empyema, or 3. no response to antibiotics treatment within three days. Exceptions: grade 4 PS as described previously [7]. We shared the results of the report, and treatment plans and chest drainage procedures were subsequently performed by pulmonologists and thoracic surgeons at our hospital and surrounding facilities. Multiple chest tubes were frequently inserted. Penicillins combined with β-lactamase inhibitors were used according to the British Thoracic Society guidelines [5]. Operative technique: An endoscope was inserted at the middle aspect of the 7th intercostal space for inspection of the pleural cavity. A transverse skin incision (approximately 5 cm) was made laterally at the largest empyema cavity level. The first step consisted of complete evacuation of the fluid component of the empyema by suction, disruption of fibrinous pleural septations, and gentle removal of minor adhesions until the empyema cavity became a single space. The next step included repeated pleural lavage with hydrogen peroxide and normal saline until the cavity was clean. Finally, 28-Fr chest tubes were placed at the apical position and on the diaphragm. A 6-Fr chest tube was inserted for irrigation. Antibiotic treatment was terminated when the serum C-reactive protein (CRP) concentration decreased to less than 5 mg/dl, and the patient was discharged 2 days later [7].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe analyses were performed using the StatMate III statistical software (ATMS Co., Ltd., Tokyo, Japan). Patient characteristics were compared using the chi-square test or Fisher\u0026rsquo;s exact test for categorical data and \u003cem\u003et\u003c/em\u003e tests for continuous data. A two-sided \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eClinical characteristics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof patients with NTM empyema and NTM disease without empyema\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical\u0026nbsp;characteristics of patients with NTM empyema and NTM disease without empyema are shown in Table 1. Among those with NTM disease without empyema, 8.7% were immunocompromised (23 were steroid users, 2 were immunosuppressant users, and 0 used anticancer drugs). Among those with NTM empyema, 38.5% were immunocompromised (5 were steroid users, 0 were immunosuppressant users, and 0 were anticancer drug users). Among those with NTM disease without empyema, 68.2% were female, and 21.5% had the fibrocavitary form. In both sexes of patients with NTM disease without empyema, the frequency of the fibrocavitary form was lower than that of the nodular/-bronchiectatic form. Thirty-seven percent of males and 14.2% of females with NTM disease without empyema had the fibrocavitary form. This finding indicated that the frequency of the fibrocavitary form was significantly higher in males than in females (P \u0026lt; 0.001). Patients with NTM empyema were significantly older, more likely to have poorer PS, be male, and have\u0026nbsp;a\u0026nbsp;higher Charlson Comorbidity Index (CCI). Patients with NTM empyema were also more likely to be immunocompromised, have the fibrocavitary form, pneumothorax, lung abscess, and lung cavitation than were the patients with NTM disease without empyema, but no significant difference in\u0026nbsp;the distribution of pathogens\u0026nbsp;was observed between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical characteristics and outcomes of patients with NTM empyema and non-NTM empyema\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical characteristics and outcomes of patients with NTM empyema and non-NTM empyema are shown in Table 2. Among those with non-NTM empyema, 11.6% were immunocompromised (11 were steroid users, 19 were immunosuppressant users, and 11 were anticancer drug users). Compared with non-NTM empyema patients, NTM empyema patients were significantly older, had poorer performance status (PS), higher CCI, and higher incidences of immunocompromise, pneumothorax, lung abscess, and lung cavitation. Other factors did not significantly differ between the two groups.\u0026nbsp;The\u0026nbsp;serum white blood cell (WBC) count was higher in the non-NTM empyema group than in the NTM empyema group, but there was no significant difference in the serum CRP level. According to the results of the pleural fluid analysis, the adenosine deaminase (ADA) level and the percentage of lymphocytes were higher in patients with NTM empyema than in patients without NTM empyema.\u0026nbsp;For treatment options, the percentage of patients who were cured of pneumothorax without surgical intervention differed significantly.\u0026nbsp;In terms of outcomes, patients with NTM empyema had significantly higher rates of complications, recurrence, and mortality than did patients without NTM empyema.\u0026nbsp;In addition, there was a statistically significant difference between the mortality rate for fistulous NTM empyema patients and that for fistulous non-NTM empyema patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical characteristics of surgically treated patients and nonsurgically treated patients with NTM empyema\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical characteristics of surgically treated patients and nonsurgically treated patients with NTM empyema are shown in Table 3. The incidence of lung cavitation at admission differed significantly between surgically treated patients and nonsurgically treated patients. The mortality rate in nonsurgically treated patients was 50%, while that in surgically treated patients was 22%, however, these two groups were not significantly different.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical course of the 13 patients with NTM empyema.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical course of the 13 NTM empyema patients is shown in Table 4. Pulmonary NTM infection was diagnosed simultaneously with empyema in 5 of 13 patients (38%). Preexisting pulmonary NTM infections were not treated with chemotherapy in 3 of 8 patients (36%). After the diagnosis of NTM empyema, 10 patients (77%) were treated with 1-3 antimycobacterial medications. Four (30.8%) patients had abscess lesions, and two patients died (50.0%). Nine (69.2%) patients had cavity lesions, and four patients died (44.4%). All patients who died had pneumothorax. All NTM empyema patients who underwent nonsurgical treatment had uniloculated empyema, and they showed some response to antibiotics or drainage treatment within three days. Two patients were cured without surgical treatment, but two patients died of bilateral pneumonia without surgical treatment. Concerning the surgical treatment for NTM empyema, there was no open window thoracotomy. Surgical intervention for a patient with a PS grade of 4 is contraindicated to our therapeutic strategy for acute empyema. However, surgical intervention was performed in one patient with a grade 4 PS because fistulous empyema was uncontrollable despite drainage and chemotherapy for more than 30 days, and she died 6 days after the operation. A 78-year-old male underwent right upper lobectomy because of a large lung cavity and abscess and died of acute exacerbation of interstitial pneumonia 10 days after the operation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNTM empyema is a rare condition that has been reported in case reports [8] and retrospective studies [5,6]. To our knowledge, the present study is the first prospective study of NTM empyema to date. Previous studies [9.10] reported that the frequency of pleural effusion in patients with pulmonary NTM was 1.4\u0026ndash;3.4%. In our study, 4.3% of patients with pulmonary NTM infection developed empyema with NTM infection isolated from pleural effusion. The most common pathogen causing pleuritis was \u003cem\u003eM. avium\u003c/em\u003e, followed by \u003cem\u003eM. kansasii\u003c/em\u003e and \u003cem\u003eM. intracellulare\u003c/em\u003e according to previous reports [11].\u003c/p\u003e \u003cp\u003ePrevious reports [5,6,10] revealed that 40\u0026ndash;70% of patients with NTM pleuritis were complicated by pneumothorax, and the mechanism of NTM pleuritis was primarily suspected to be the perforation of pulmonary NTM disease or the spread of inflammation to the pleura [5,6,10,12]. Our study revealed that NTM empyema patients had significantly higher incidences of pneumothorax, lung abscess and lung cavitation than did non-NTM empyema patients. The percentage of patients with NTM empyema who were cured of pneumothorax without surgical intervention was significantly lower (15.4%) than that of patients with non-NTM empyema (78.0%). This result may support the idea that NTM empyema can develop through leakage or perforation without empyema, and that bronchopleural fistulas are more common in NTM empyema.\u003c/p\u003e \u003cp\u003eSugiura et al. [13] reported that the mortality rate was 3.8% for nonfistulous empyema and 44.4% for fistulous empyema. In our study, the mortality rate was 0% for nonfistulous NTM empyema, but the mortality rate was 44.4% for fistulous NTM empyema, although the mortality rate was 12.0% for fistulous non-NTM empyema. Our study revealed that NTM empyema patients had a poorer prognosis than did non-NTM empyema patients, and the causative factors might be older age, poorer PS, and higher incidences of lung cavitation, lung abscess and pneumothorax. However, there was no significant difference in the mortality rate between surgically treated patients with NTM empyema and patients without NTM empyema. Therefore, early surgical intervention should also be considered for patients with fistulous NTM empyema.\u003c/p\u003e \u003cp\u003eIn a previous study [7], researchers suggested that reducing the time from hospitalization at their hospital to surgical intervention reduced the mortality rate. We recommend early surgical intervention for fistulous NTM empyema patients in addition to our 3 applied procedures. We believe that the appropriate timing for early surgical intervention should be within 3 days of admission to our hospital according to our therapeutic strategy for acute empyema.\u003c/p\u003e \u003cp\u003ePrevious reports [5,6,10,12,14] revealed that the outcome of treatment for NTM empyema appears to be worse than that for NTM disease without empyema, and the hospital mortality rate is 25\u0026ndash;29% [12,14]. The authors also emphasized the importance of immediate therapy, especially drainage and surgical intervention, using a multidisciplinary approach for treating NTM empyema. In this study, the hospital mortality rate was 30.8% (4 of 13 patients), which was comparable to or slightly worse than that in previous reports [12,14], even though our patients were older and had a worse PS.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, this study involved a prospective analysis of all empyema patients from a single institution, but 53.8% of NTM empyema patients and 46.2% of non-NTM empyema patients were transferred from surrounding hospitals due to failed therapy before they were hospitalized at our hospital. Therefore, selection bias was inevitable. Second, because NTM disease without empyema was confirmed in patients from a single institution, these patients might not be representative of national populations. Finally, since NTM empyema is a rare condition, the number of patients examined in our study was small. The size of the sample of patients with NTM empyema was much smaller than that of patients without NTM empyema, and the statistical analysis may not be valid. However, additional large sample studies are needed to confirm our results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo our knowledge, the present study is the first prospective study of NTM empyema to date. This study revealed that NTM empyema has a poor prognosis and is difficult to treat with medication alone. Fistulous NTM empyema should also be added to the indications for surgical intervention. Early surgical intervention should be considered for select patients with NTM empyema.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eM\u0026nbsp;Mycobacterium\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNTM Nontuberculous mycobacteria\u003c/p\u003e\n\u003cp\u003ePS Performance Status\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEnglish proofreading:\u003c/strong\u003e Springer Nature Author Services\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003eHS contributed to the data collection, analysis, and interpretation and wrote the initial paper. DI, MS and SS contributed to the data analysis and interpretation and drafted and edited the article. All authors approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThe study was self-funded by the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e Data generated in this study are available from the corresponding author upon reasonable request with a completed Materials Transfer Agreement, excluding the materials including personally identifiable information.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Institutional Ethical Committee of Mie Prefectural General Medical Center, Japan. Written informed consent was obtained from all participants who voluntarily agreed to participate in the study after the research procedure and objectives of the study were explained in simple, clear language. Participants were reassured that the data collected would be confidential and would be used for research purposes only. It was clearly explained that participation in this study was voluntary, and the participant had the right to withdraw at any time without any deprivation. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003es The authors have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDaley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ Jr, Andrejak C et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020;71:905-13.\u003c/li\u003e\n \u003cli\u003eIzumi K, Morimoto K, Hasegawa N, Uchimura K, Kawatsu L, Ato M, et al. Epidemiology of Adults and Children Treated for Nontuberculous Mycobacterial Pulmonary Disease in Japan. Ann Am Thorac Soc. 2019;16:341-7.\u003c/li\u003e\n \u003cli\u003eWen P, Wei M, Han C, He Y, Wang MS. Risk factors for tuberculous empyema in pleural tuberculosis patients. Sci Rep. 2019;9:19569.\u003c/li\u003e\n \u003cli\u003eVald\u0026eacute;s L, Alvarez D, San Jos\u0026eacute; E, Penela P, Valle JM, Garc\u0026iacute;a-Pazos JM et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998;158:2017-21.\u003c/li\u003e\n \u003cli\u003eWen P, Wei M, Xu YR, Dong L. Clinical Relevance and Characteristics of Nontuberculous Mycobacterial Pleuritis. Jpn J Infect Dis. 2020;73:282-7.\u003c/li\u003e\n \u003cli\u003eYagi K, Ito A, Fujiwara K, Morino E, Hase I, Nakano Y et al. Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis: A Multicenter Retrospective Study.Ann Am Thorac Soc. 2021;18:1490-7.\u003c/li\u003e\n \u003cli\u003eSuzuki H, Shomura S, Sawada Y, Shimamoto A, Kondo C, Takao M et al. Therapeutic strategy for acute pleural empyema: comparison between retrospective study and prospective study. Gen Thorac Cardiovasc Surg. 2019;67:1048-1055.\u003c/li\u003e\n \u003cli\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003eAnjum S, Tahir R, Pathan SA. Nontuberculous mycobacterial infection presenting as empyema and life threatening pneumothorax: A challenging situation in the emergency department. Qatar Med J. 2015:8.\u003c/li\u003e\n \u003cli\u003eKobashi Y, Mouri K, Obase Y, Kato S, Oka M. Clinical analysis of patients with pulmonary nontuberculous mycobacterial disease complicated by pneumothorax. Intern Med 2013;52: 2511-5.\u003c/li\u003e\n \u003cli\u003eAndo T, Kawashima M, Matsui H, Takeda K, Sato R, Ohshima N et al. Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis. Respiration. 2018;96:507-13.\u003c/li\u003e\n \u003cli\u003eUeyama M, Asakura T, Morimoto K, Namkoong H, Matsuda S, Osawa T et al.Pneumothorax associated with nontuberculous mycobacteria: A retrospective study of 69 patients. Medicine 2016;95(29):e4246.\u003c/li\u003e\n \u003cli\u003eNaito M, Maekura T, Kurahara Y, Tahara M, Ikegami N, Kimura Y et al. Clinical Features of Nontuberculous Mycobacterial Pleurisy: A Review of 12 Cases. Intern Med. 2018;57:13-6.\u003c/li\u003e\n \u003cli\u003eSugiura Y, Nakamura M, Fujimoto H, Ochiai H, Ohkubo Y, Fusegawa H et al. An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula. Gen Thorac Cardiovasc Surg. 2023;71:657-64.\u003c/li\u003e\n \u003cli\u003ePark S, Jo KW, Lee SD, Kim WS, Shim TS. Clinical characteristics and treatment outcomes of pleural effusions in patients with nontuberculous mycobacterial disease. Respir Med. 2017:133:36-41.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 The clinical characteristics of patients with NTM empyema and NTM disease without empyema.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.30232558139535%\" valign=\"top\"\u003e\n \u003cp\u003eValuables\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003cp\u003eCCI\u003c/p\u003e\n \u003cp\u003ePerformance Status (PS)\u003c/p\u003e\n \u003cp\u003eOther lung disease, %\u003c/p\u003e\n \u003cp\u003eImmunocompromised patients, %\u003c/p\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003cp\u003eRadiological findings\u003c/p\u003e\n \u003cp\u003eNodular/- bronchiectatic form\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Gender (male/female)\u003c/p\u003e\n \u003cp\u003eFibrocavitary form\u003c/p\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003cp\u003ePneumothorax, %\u003c/p\u003e\n \u003cp\u003elung abscess, %\u003c/p\u003e\n \u003cp\u003elung cavitation, %\u003c/p\u003e\n \u003cp\u003ePathogens\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003cem\u003eM. avium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003cem\u003eM. intracellulare\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eM. kansasii\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eM. abscessus\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.401162790697676%\" valign=\"top\"\u003e\n \u003cp\u003eNTM empyema\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 13)\u003c/p\u003e\n \u003cp\u003e78 (50-91\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e8/5\u003c/p\u003e\n \u003cp\u003e6 (2-14)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3 (0-4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;6 (46.2)\u003c/p\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003cp\u003e18.5 (11.5-25.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003cp\u003e3/2\u003c/p\u003e\n \u003cp\u003e8 (61.5)\u003c/p\u003e\n \u003cp\u003e5/3\u003c/p\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;4 (30.8)\u003c/p\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (69.2) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2 (15.4)\u003c/p\u003e\n \u003cp\u003e0 ( 0.0)\u003c/p\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003cp\u003e0 ( 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.540697674418606%\" valign=\"top\"\u003e\n \u003cp\u003eNTM disease without empyema (n = 289)\u003c/p\u003e\n \u003cp\u003e68 (26-96)\u003c/p\u003e\n \u003cp\u003e92/197\u003c/p\u003e\n \u003cp\u003e4 (0-10)\u003c/p\u003e\n \u003cp\u003e0 (0-3)\u003c/p\u003e\n \u003cp\u003e72 (24.9)\u003c/p\u003e\n \u003cp\u003e25 ( 8.7)\u003c/p\u003e\n \u003cp\u003e19.5 (10.4-33.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e227 (78.5)\u003c/p\u003e\n \u003cp\u003e58/169\u003c/p\u003e\n \u003cp\u003e62 (21.5)\u003c/p\u003e\n \u003cp\u003e34/28\u003c/p\u003e\n \u003cp\u003e0 ( 0.0)\u003c/p\u003e\n \u003cp\u003e0 ( 0.0)\u003c/p\u003e\n \u003cp\u003e76 (26.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e191 (66.1)\u003c/p\u003e\n \u003cp\u003e61 (21.1)\u003c/p\u003e\n \u003cp\u003e17 ( 5.9)\u003c/p\u003e\n \u003cp\u003e9 ( 3.1)\u003c/p\u003e\n \u003cp\u003e11 ( 3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.755813953488373%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are number of patients (%), median or range.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNTM\u003c/strong\u003e, nontuberculous mycobacteria;\u003cstrong\u003e\u0026nbsp;M.,\u003c/strong\u003e Mycobacterium; \u003cstrong\u003eCCI,\u0026nbsp;\u003c/strong\u003eCharlson Comorbidity Index\u003c/p\u003e\n\u003cp\u003eTable 2 Clinical characteristics and outcomes of patients with NTM empyema and non-NTM empyema\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.25253991291727%\" valign=\"top\"\u003e\n \u003cp\u003eValuables\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003cp\u003eCCI\u003c/p\u003e\n \u003cp\u003ePerformance Status (PS)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePast history of NTM, %\u003c/p\u003e\n \u003cp\u003eOther lung disease, %\u003c/p\u003e\n \u003cp\u003eImmunocompromised patients, %\u003c/p\u003e\n \u003cp\u003eSerum WBC\u0026nbsp;(/ml)\u003c/p\u003e\n \u003cp\u003eSerum CRP\u0026nbsp;(mg/dl) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePleural fluid analysis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;pH\u003c/p\u003e\n \u003cp\u003eLDH (IU/L)\u003c/p\u003e\n \u003cp\u003eTotal protein (g/dl)\u003c/p\u003e\n \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;ADA (U/L)\u003c/p\u003e\n \u003cp\u003eWBC (/ml)\u003c/p\u003e\n \u003cp\u003eNeutrophil, %\u003c/p\u003e\n \u003cp\u003eLymphocyte, %\u003c/p\u003e\n \u003cp\u003ePneumothorax, %\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Mortality, %\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Cured without operation, %\u003c/p\u003e\n \u003cp\u003eMultiloculated empyema, %\u003c/p\u003e\n \u003cp\u003elung abscess, %\u003c/p\u003e\n \u003cp\u003elung cavitation, %\u003c/p\u003e\n \u003cp\u003eDrainage, %\u003c/p\u003e\n \u003cp\u003eSurgical treatment, %\u003c/p\u003e\n \u003cp\u003eDrain retention days\u003c/p\u003e\n \u003cp\u003eAntibiotic administration days\u003c/p\u003e\n \u003cp\u003eHospitalization days\u003c/p\u003e\n \u003cp\u003eComplication, %\u003c/p\u003e\n \u003cp\u003eRecurrence, %\u003c/p\u003e\n \u003cp\u003eMortality, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.124818577648767%\" valign=\"top\"\u003e\n \u003cp\u003eNTM empyema\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n = 13)\u003c/p\u003e\n \u003cp\u003e78 \u003cu\u003e(\u003c/u\u003e50-91\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e8/5\u003c/p\u003e\n \u003cp\u003e6 (2-14)\u003c/p\u003e\n \u003cp\u003e3 \u003cu\u003e(\u003c/u\u003e0-4\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e8 (61.5)\u003c/p\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003cp\u003e5 (38.5)\u003c/p\u003e\n \u003cp\u003e10800 \u003cu\u003e(\u003c/u\u003e4100-34800\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e19.9 \u003cu\u003e(\u003c/u\u003e5.50-30.13\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.295 \u003cu\u003e(\u003c/u\u003e6.545-7.766\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e1432 \u003cu\u003e(\u003c/u\u003e254-38120\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e4.3 \u003cu\u003e(\u003c/u\u003e3.1-5.0\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e57 \u003cu\u003e(\u003c/u\u003e0-128\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e80.6 (16-182)\u003c/p\u003e\n \u003cp\u003e19400 (4770-211296)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 64.1 (14.5-82.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 26.3 (0.1-80.7)\u003c/p\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003cp\u003e4 (44.4)\u003c/p\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003cp\u003e10 (76.9)\u003c/p\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;9.5 (8-27)\u003c/p\u003e\n \u003cp\u003e13 (3-31)\u003c/p\u003e\n \u003cp\u003e23 (11-65)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;8 (61.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 1 ( 7.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 4 (30.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.124818577648767%\" valign=\"top\"\u003e\n \u003cp\u003enon-NTM empyema\u003c/p\u003e\n \u003cp\u003e(n = 351)\u003c/p\u003e\n \u003cp\u003e72 (15-93)\u003c/p\u003e\n \u003cp\u003e282/69\u003c/p\u003e\n \u003cp\u003e5 (0-14)\u003c/p\u003e\n \u003cp\u003e1 (0-4)\u003c/p\u003e\n \u003cp\u003e7 ( 2.0)\u003c/p\u003e\n \u003cp\u003e83 (23.6)\u003c/p\u003e\n \u003cp\u003e41 (11.6)\u003c/p\u003e\n \u003cp\u003e14400(2900-57500)\u003c/p\u003e\n \u003cp\u003e18.5(4.09-54.40)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.224 (6.000-7.766)\u003c/p\u003e\n \u003cp\u003e1067 (25-73200)\u003c/p\u003e\n \u003cp\u003e4.6 (0.6-7.5)\u003c/p\u003e\n \u003cp\u003e48 (0-547)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 29.4 (3.3-440)\u003c/p\u003e\n \u003cp\u003e9400 (171-513372)\u003c/p\u003e\n \u003cp\u003e78.2 (2-98)\u003c/p\u003e\n \u003cp\u003e8.2 (0-90)\u003c/p\u003e\n \u003cp\u003e50 (14.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;6 (12.0)\u003c/p\u003e\n \u003cp\u003e39 (78.0)\u003c/p\u003e\n \u003cp\u003e50 (14.2)\u003c/p\u003e\n \u003cp\u003e21 ( 6.0)\u003c/p\u003e\n \u003cp\u003e135 (38.4)\u003c/p\u003e\n \u003cp\u003e314 (89.5)\u003c/p\u003e\n \u003cp\u003e151 (43.0)\u003c/p\u003e\n \u003cp\u003e11 (2-74)\u003c/p\u003e\n \u003cp\u003e14 (3-123)\u003c/p\u003e\n \u003cp\u003e20 (3-256)\u003c/p\u003e\n \u003cp\u003e56 (16.0) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 3 ( 0.9)\u003c/p\u003e\n \u003cp\u003e38 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.497822931785196%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0.58\u003c/p\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0.07\u003c/p\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are number of patients (%), median or range.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNTM,\u0026nbsp;\u003c/strong\u003enontuberculous mycobacteria; \u003cstrong\u003eCCI,\u0026nbsp;\u003c/strong\u003eCharlson Comorbidity Index\u003cstrong\u003e; pH,\u003c/strong\u003e power of hydrogen; \u003cstrong\u003eWBC,\u003c/strong\u003e white blood cells; \u003cstrong\u003eCRP,\u003c/strong\u003e C-reactive protein; \u003cstrong\u003eLDH,\u003c/strong\u003e Lactate Dehydrogenase \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Clinical characteristics of surgically treated patients and nonsurgically treated patients with NTME \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.859154929577464%\" valign=\"top\"\u003e\n \u003cp\u003eValuables\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003cbr\u003e\u0026nbsp;\u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003cp\u003eCCI\u003c/p\u003e\n \u003cp\u003ePerformance Status (PS)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOther lung disease, %\u003c/p\u003e\n \u003cp\u003eImmunocompromised patients, %\u003c/p\u003e\n \u003cp\u003eSerum WBC\u0026nbsp;(/ml)\u003c/p\u003e\n \u003cp\u003eSerum CRP(mg/dl) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTime from onset to hospitalization at our hospital (days)\u003c/p\u003e\n \u003cp\u003ePleural fluid analysis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;pH\u003c/p\u003e\n \u003cp\u003eLDH (IU/L)\u003c/p\u003e\n \u003cp\u003eTotal protein (g/dl)\u003c/p\u003e\n \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e\n \u003cp\u003eADA (U/L)\u003c/p\u003e\n \u003cp\u003eWBC (/ml)\u003c/p\u003e\n \u003cp\u003eNeutrophil, %\u003c/p\u003e\n \u003cp\u003eLymphocyte, %\u003c/p\u003e\n \u003cp\u003ePneumothorax, %\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Mortality, %\u003c/p\u003e\n \u003cp\u003eMultiloculated empyema, %\u003c/p\u003e\n \u003cp\u003elung abscess, %\u003c/p\u003e\n \u003cp\u003elung cavitation, %\u003c/p\u003e\n \u003cp\u003eAntibiotic administration days\u003c/p\u003e\n \u003cp\u003eHospitalization days\u003c/p\u003e\n \u003cp\u003eComplication, %\u003c/p\u003e\n \u003cp\u003eMortality, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.35211267605634%\" valign=\"top\"\u003e\n \u003cp\u003esurgically treated with NTME (n = 9)\u003c/p\u003e\n \u003cp\u003e78 \u003cu\u003e(\u003c/u\u003e50-91\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e5/4\u003c/p\u003e\n \u003cp\u003e6 (2-12)\u003c/p\u003e\n \u003cp\u003e2 \u003cu\u003e(\u003c/u\u003e0-4\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e3 (33.3)\u003c/p\u003e\n \u003cp\u003e3 (33.3)\u003c/p\u003e\n \u003cp\u003e9900 \u003cu\u003e(\u003c/u\u003e4100-34800\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e22.8 (5.50-30.13\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (4-30)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.396 \u003cu\u003e(\u003c/u\u003e6.545-7.766\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e2187 \u003cu\u003e(\u003c/u\u003e254-38120\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e4.5\u003cu\u003e(\u003c/u\u003e3.1-5.0\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e54 \u003cu\u003e(\u003c/u\u003e0-107\u003cu\u003e)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e99.7 (20.2-168)\u003c/p\u003e\n \u003cp\u003e2840 (470-211296)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 72.2 (14.5-82.1)\u003c/p\u003e\n \u003cp\u003e24.5 (0.1-80.7)\u003c/p\u003e\n \u003cp\u003e7 (77.8)\u003c/p\u003e\n \u003cp\u003e2 (28.6)\u003c/p\u003e\n \u003cp\u003e4 (44.4)\u003c/p\u003e\n \u003cp\u003e2 (22.2)\u003c/p\u003e\n \u003cp\u003e8 (88.9)\u003c/p\u003e\n \u003cp\u003e8 (3-54)\u003c/p\u003e\n \u003cp\u003e23 (12-65)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;5 (55.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2 (22.2)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.676056338028168%\" valign=\"top\"\u003e\n \u003cp\u003enonsurgically treated with NTME (n = 4)\u003c/p\u003e\n \u003cp\u003e76 (60-82)\u003c/p\u003e\n \u003cp\u003e3/1\u003c/p\u003e\n \u003cp\u003e9 (6-14)\u003c/p\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003cp\u003e3 (75.0)\u003c/p\u003e\n \u003cp\u003e2 (50.0)\u003c/p\u003e\n \u003cp\u003e11050(9700-15300)\u003c/p\u003e\n \u003cp\u003e23.5 (10.4-22.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (0-15)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.123 (6.894-7.238)\u003c/p\u003e\n \u003cp\u003e1382 (337-2561)\u003c/p\u003e\n \u003cp\u003e4.0 (3.4-4.6)\u003c/p\u003e\n \u003cp\u003e94 (32-124)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 44.7 (16-80.6)\u003c/p\u003e\n \u003cp\u003e1380(830-24900)\u003c/p\u003e\n \u003cp\u003e49.4 (40.5-87.9)\u003c/p\u003e\n \u003cp\u003e32.5 (5-43.9)\u003c/p\u003e\n \u003cp\u003e2 (50.0)\u003c/p\u003e\n \u003cp\u003e2 (100)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e1 (25.0)\u003c/p\u003e\n \u003cp\u003e1 (25.0)\u003c/p\u003e\n \u003cp\u003e24 (11-31)\u003c/p\u003e\n \u003cp\u003e18 (6-52)\u003c/p\u003e\n \u003cp\u003e2 (50.0) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.112676056338028%\" valign=\"top\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0.07\u003c/p\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0.96\u003c/p\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.05\u003c/p\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are number of patients (%), median or range.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNTM,\u0026nbsp;\u003c/strong\u003enontuberculous mycobacteria;\u003cstrong\u003e\u0026nbsp;NTME,\u0026nbsp;\u003c/strong\u003eNTM empyema; \u003cstrong\u003eCCI,\u0026nbsp;\u003c/strong\u003eCharlson Comorbidity Index;\u003cstrong\u003e\u0026nbsp;pH,\u003c/strong\u003e power of hydrogen; \u003cstrong\u003eWBC,\u003c/strong\u003e white blood cells; \u003cstrong\u003eCRP,\u003c/strong\u003e C-reactive protein; \u003cstrong\u003eLDH,\u003c/strong\u003e Lactate Dehydrogenase,\u003c/p\u003e\n\u003cp\u003eTable 5 Clinical course of the 13 patients with NTM empyema.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"2003\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.688279301745636%\" valign=\"top\"\u003e\n \u003cp\u003eAge(years) \u0026nbsp;Sex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003cbr\u003e\u0026nbsp;\u003cp\u003e82, male\u003c/p\u003e\n \u003cp\u003e79, male\u003c/p\u003e\n \u003cp\u003e50, male\u003c/p\u003e\n \u003cp\u003e77, female\u003c/p\u003e\n \u003cp\u003e91, male\u003c/p\u003e\n \u003cp\u003e68, female\u003c/p\u003e\n \u003cp\u003e68, male\u003c/p\u003e\n \u003cp\u003e71, female\u003c/p\u003e\n \u003cp\u003e82, male\u003c/p\u003e\n \u003cp\u003e78, male\u003c/p\u003e\n \u003cp\u003e60, male\u003c/p\u003e\n \u003cp\u003e88, female\u003c/p\u003e\n \u003cp\u003e86, female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.635910224438903%\" valign=\"top\"\u003e\n \u003cp\u003eTime from lung NTM to empyema\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003cp\u003esimultaneous\u003c/p\u003e\n \u003cp\u003esimultaneous\u003c/p\u003e\n \u003cp\u003e10 years\u003c/p\u003e\n \u003cp\u003e1 years\u003c/p\u003e\n \u003cp\u003e3 years\u003c/p\u003e\n \u003cp\u003esimultaneous\u003c/p\u003e\n \u003cp\u003e4 months\u003c/p\u003e\n \u003cp\u003esimultaneous\u003c/p\u003e\n \u003cp\u003esimultaneous\u003c/p\u003e\n \u003cp\u003e15 years\u003c/p\u003e\n \u003cp\u003e7 years\u003c/p\u003e\n \u003cp\u003e4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.134663341645886%\" valign=\"top\"\u003e\n \u003cp\u003ePathogens\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eM. intracellulare\u003c/em\u003e M.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM. \u003cem\u003eabscessus\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eM. intracellulare\u003c/em\u003e M.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM. \u003cem\u003eabscessus\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eM.\u003cem\u003eavium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.7905236907730675%\" valign=\"top\"\u003e\n \u003cp\u003eChemo-therapy before empyema\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.291770573566085%\" valign=\"top\"\u003e\n \u003cp\u003eCT findings\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNB\u003c/p\u003e\n \u003cp\u003eNB\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eNB\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eNB\u003c/p\u003e\n \u003cp\u003eNB\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003cp\u003eFC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.291770573566085%\" valign=\"top\"\u003e\n \u003cp\u003ePneumo-thorax\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.291770573566085%\" valign=\"top\"\u003e\n \u003cp\u003eLung abscess\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.239401496259352%\" valign=\"top\"\u003e\n \u003cp\u003eLung cavitation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.8952618453865338%\" valign=\"top\"\u003e\n \u003cp\u003ePS\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;4\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.7905236907730675%\" valign=\"top\"\u003e\n \u003cp\u003eChemo-therapy after empyema\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.7905236907730675%\" valign=\"top\"\u003e\n \u003cp\u003eDrainage\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.738154613466334%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical\u003c/p\u003e\n \u003cp\u003etreatment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+), S\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+), L\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.508728179551124%\" valign=\"top\"\u003e\n \u003cp\u003ehospital\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emortality\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; (-)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; (-)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(+)\u003c/p\u003e\n \u003cp\u003e(-)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;(-)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.456359102244388%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.456359102244388%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eM,\u003c/strong\u003e mycobacterium\u003cstrong\u003e; NB,\u003c/strong\u003e nodular/-bronchiectatic form; \u003cstrong\u003eFC,\u003c/strong\u003e fibrocavitary form; \u003cstrong\u003ePS,\u0026nbsp;\u003c/strong\u003ePerformance status; \u003cstrong\u003eS,\u003c/strong\u003e Segmentectomy; \u003cstrong\u003eL,\u003c/strong\u003e Lobectomy\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nontuberculous mycobacteriosis, Pleural empyema, Prospective study, Pneumothorax","lastPublishedDoi":"10.21203/rs.3.rs-4608859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4608859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e The purpose of this study was to clarify the clinical characteristics and report the efficacy of our therapeutic strategy for treating nontuberculous mycobacterial empyema (NTM empyema).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cem\u003e \u003c/em\u003eThe medical records of 302 patients with pulmonary nontuberculous mycobacterial (NTM) disease were retrospectively reviewed, and 364 patients with acute empyema were prospectively reviewed to select patients complicated by NTM empyema from September 2014 to December 2022 in our hospital. NTM empyema was defined as a positive NTM culture of pleural effusion samples.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 304 patients with pulmonary NTM, 13 had NTM empyema (4.3%). The mean age was 78 years, the mean performance status (PS) was 3, and 9 patients (69.2%) had pneumothorax. Age, male sex, comorbidities, fibrocavitary forms, pneumothorax, and lung cavitation were more common in patients with NTM empyema than in patients without NTM disease. Age, PS, comorbidity rate, pneumothorax incidence, and mortality rate were higher in the NTM empyema group than in the non-NTM empyema group. Similarly, the percentage of patients who were cured of pneumothorax without surgical intervention was significantly lower in the NTM empyema group (15.4%) than in the non-NTM empyema group (78.0%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed that NTM empyema has a poor prognosis and is difficult to treat with medication alone. Fistulous NTM empyema should also be added to the indications for surgical intervention. Early surgical intervention should be considered for selected patients with NTM empyema.\u003c/p\u003e","manuscriptTitle":"Clinical characteristics and prognosis of nontuberculous mycobacterial empyema: Comparison with nontuberculous mycobacterial disease without empyema and nonnontuberculous mycobacterial empyema","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-25 08:33:29","doi":"10.21203/rs.3.rs-4608859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"595916e5-1fff-40b4-870a-268d110cc0e8","owner":[],"postedDate":"July 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-17T07:31:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-25 08:33:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4608859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4608859","identity":"rs-4608859","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}