Evaluating treatment success in bacterial pleural space infections: A laboratory and imaging approach

Context: Bacterial pleural space infections continue to cause significant morbidity and mortality. Parapneumonic effusions (PPE) and tuberculous pleural effusions (TPE) are among the most common types, often complicating pneumonia and tuberculosis. Treatment response varies based on clinical, biochemical, and microbiological parameters. Aims: To assess clinical and laboratory parameters influencing treatment outcomes in bacterial pleural space infections. Settings and Design: Cross-sectional observational study. Materials and Methods: A cross-sectional study was conducted in the Department of Respiratory Medicine at a tertiary care center between August 2022 and June 2024. One hundred adult patients with bacterial and tuberculous pleural effusions were included. Clinical features, pleural fluid biochemistry, culture results, and thoracoscopic findings were recorded. Treatment outcomes were classified as success (symptom resolution within 2 weeks) or failure (persistent infection, need for surgery, or death). Data were analyzed using SPSS v16. Results: Among patients with fever ( n = 27), 22 experienced treatment failure. The mean WBC count in failures was 26,817.68 ± 6291.48. Pleural fluid protein and LDH were higher in failures (3.49 ± 0.29 g/dL and 653.18 ± 258.04 IU/L, respectively). ADA >40 IU/L was seen in 22 of the failures. Culture positivity was higher among failures (16/22), with Staphylococci more common. Thoracoscopic biopsy revealed fibrotic peel in failures versus nodules in successful outcomes. Conclusion: Early identification of high-risk patients using pleural fluid markers and thoracoscopic findings can guide effective treatment and improve outcomes.