Microbiological Characteristics according to Transudative and Exudative Effusion in Pleural Fluid Culture

Hyeun Gyeo Lee; Gyu Yel Hwang; Soon Deok Park; Young Uh; Juwon Kim; Kap Jun Yoon; Won-Yeon Lee

doi:10.5145/ACM.2015.18.2.52

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Lee, Hwang, Park, Uh, Kim, Yoon, and Lee: Microbiological Characteristics according to Transudative and Exudative Effusion in Pleural Fluid Culture

Original Article

Ann Clin Microbiol 2015;18(2):52-55.

Published online: 5 June 2015

DOI: https://doi.org/10.5145/ACM.2015.18.2.52

Microbiological Characteristics according to Transudative and Exudative Effusion in Pleural Fluid Culture

Hyeun Gyeo Lee¹, Gyu Yel Hwang¹, Soon Deok Park¹, Young Uh¹, Juwon Kim¹, Kap Jun Yoon¹, Won-Yeon Lee²

¹Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

²Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence: Young Uh, Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 220-701, Korea.(Tel) 82-33-741-1592, (Fax) 82-33-731-0506, (E-mail) u931018@yonsei.ac.kr

Received 16 October 201411 February 2015 Accepted 1 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

A total of 1,132 pleural fluid culture results obtained from October 2012 to July 2014 were analyzed to eluci-date the microbiological characteristics according to transudative and exudative pleural fluid. The pleural fluid cultures were performed using aerobic and anaerobic blood culture bottles. The blood and pleural fluid for total protein, lactate dehydrogenase, and glucose measurement were submitted to laboratory at the same time with pleural fluid cultures. The rates for culture positivity, anaerobes isolation, and polymicrobials between transudative and exudative pleural fluid were 5.2% vs. 10.4%, 14.8% vs. 7.8%, and 14.8% vs. 10.9%.

Keywords: Anaerobe, Culture, Exudate, Pleural fluid, Transudate

REFERENCES

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Table 1.

Isolation rates of organisms according to transudate and exudate in pleural fluid specimens

Culture results	No.	Characteristics of pleural fluid
Culture results	No.	Transudate	Exudate
Culture negative	1,041	490(94.8)	551(89.6)
Culture positive	91	27(5.2)	64(10.4)∗
Gram-positive cocci
Staphylococcus aureus	6	2(0.4)	4(0.7)
Staphylococcus epidermidis	13	4(0.8)	7(1.1)
Staphylococcus haemolyticus	5	3(0.6)	2(0.3)
Staphylococcus hominis	5	3(0.6)	2(0.3)
Staphylococcus ureolyticus	3	0	3(0.5)
Staphylococcus capitis	2	0	2(0.3)
Staphylococcus auricularis	1	0	1(0.2)
Viridans group streptococci	10	2(0.4)	8(1.3)
Streptococcus pneumoniae	1	0	1(0.2)
Enterococcus spp.	5	1(0.2)	4(0.7)
Micrococcus spp.	3	1(0.2)	2(0.3)
Non-fermentative gram-negative bacilli
Acinetobacter baumannii complex	6	1(0.2)	5(0.8)
Acinetobacter junii	1	1(0.2)	0
Alcaligenes xylosoxidans	1	0	1(0.2)
Enterobacteriaceae
Escherichia coli	4	1(0.2)	3(0.5)
Klebsiella pneumoniae	2	0	2(0.3)
Proteus mirabilis	1	0	1(0.2)
Gram-positive bacilli
Bacillus spp.	1	0	1(0.2)
Corynebacterium spp.	1	0	1(0.2)
Anaerobes
Propionibacterium acnes	4	1(0.2)	3(0.5)
Peptostreptococcus asaccharolyticus	1	0	1(0.2)
Prevotella spp.	1	1(0.2)	0
Fungus
Candida glabrata	2	2(0.4)	0
Candida albicans	1	0	1(0.2)
Candida tropicalis	1	0	1(0.2)
Aspergillus spp.	1	0	1(0.2)
Polymicrobials	11	4†(0.8)	7‡(1.1)
Total	1,132	517(100.0)	615(100.0)

^∗ P=0.001.

^† Streptococcus constellatus/K. pneumoniae/Clostridium perfringens (1), S. aureus/Streptococcus mitis/K. pneumoniae (1), Streptococcus anginosus/Prevotella buccae (1), and S. mitis/Streptococcus salivarius (1).

^‡ Enterococcus faecium/Morganella morganii/Cryptococcus laurentii (1), Streptococcus parasanguis/Neisseria sicca/Lactobacillus acidophilus (1), S. aureus/Acinetobacter baumannii (1), Staphylococcus warneri/S. anginosus (1), S. aureus/A. baumannii (1), E. faecalis/Serratia marcescens (1), and S. aureus/Neisseria cinerea (1).

Table 2.

Parameter characteristics of transudate (n=517) and exudate (n=615) according to culture results in pleural fluid specimens

Parameters	Mean and P values
	Transudate			Exudate
	Culture negative (490)*	Culture positive (27)*	P value	Culture negative (551)*	Culture positive (64)*	P value
Age (yr)	70.9	68.8	0.464	66.8	66.4	0.853
Interval†	6.75	6.26	0.896	5.27	6.55	0.602
Aerobic culture volume	8.49	8.65	0.856	7.74	6.53	0.063
Anaerobic culture volume	8.34	8.23	0.911	7.76	6.45	0.050
Detection time (hr)		34.9			28.2
RBC (10³/μ L)	7.8	9.9	0.772	101.8	106.0	0.941
WBC (10³/μ L)	0.54	1.35	0.106	2.80	6.47	0.072
Neutrophil (%)	21.9	43.4	0.008∗	36.1	68.6	0.000
Lymphocyte (%)	50.1	34.7	0.024	50.2	20.6	0.000
Glucose (mg/dL)	152.2	113.6	0.002	122.0	81.8	0.000
＜40	(0)∗	(4)∗		(36)∗	(25)∗
≥40	(490)∗	(23)∗	0.000	(515)∗	(39)∗	0.000
Total protein (g/dL)	1.95	1.92	0.887	3.82	3.51	0.115
Albumin (g/dL)	1.05	0.85	0.065	2.03	1.67	0.000
LDH (U/L)	104.7	96.3	0.260	591.0	3,085.3	0.005
＜1,000	(490)∗	(27)∗		(491)∗	(42)∗
≥1,000	(0)∗	(0)∗		(60)∗	(22)∗	0.000
Ratio (PF/serum)
Glucose	1.18	1.18	0.974	0.97	0.59	0.000
Total protein	0.34	0.32	0.422	0.63	0.59	0.157
LDH	0.33	0.32	0.594	1.98	11.24	0.002
Difference (Serum – PF)
Total protein (g/dL)	3.66	3.87	0.384	2.18	2.29	0.366
Albumin (g/dL)	1.82	1.76	0.623	0.93	1.10	0.035

^∗ Numbers in parenthesis mean numbers of specimen.

^† Time interval between admission day and request day of pleural fluid culture.

Abbreviations: RBC, red blood cell; WBC, white blood cell; LDH, lactate dehydrogenase; PF, pleural fluid.

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