Evolving Patterns of Antibiotic Resistance in Empyema Thoracis: A Descriptive Case Series Analysis from Services Hospital Lahore

Objective: To characterize the microbiological spectrum and antibiotic susceptibility patterns of pathogens causing empyema thoracis in adults at a tertiary care hospital in Lahore, and to describe the prevalence and temporal trends of multidrug-resistant (MDR) isolates. Methodology: This observational study comprises 581 cases of bacterial empyema thoracis in patients admitted to the Thoracic Surgery Department, Services Hospital, Lahore, Pakistan, from March 2023 to February 2025. We collected the patient’s demographic data, culture results, and patterns of antibiotic sensitivity and resistance. Adults aged ≥18 years were included in the study. Descriptive variables were analyzed as means and frequencies. An independent t-test was applied to compare resistance to antibiotics in gram-negative and gram-positive organisms. Results: This study includes 581 cases of empyema thoracis, out of which 527 cases show positive bacterial culture growth and 54 cases show no growth on culture. From a total of 527 bacterial cultures, 274 (52%) were Multidrug-resistant (MDR). Multidrug-resistant prevalence fluctuated across half-year periods, ranging from 53.7% to 62.7%. Among positive cultures; most common Bacteria isolated was Pseudomonas aeruginosa in 167 (32%) patients, this was followed by Klebsiella pneumonaie in 51 (10%), Acinetobacter species in 47 (9%), E. coli in 48 (9%) and other gram negative organisms. Meropenem shows the highest sensitivity followed by gentamycin. Conclusion: Empyema thoracis remains prevalent in our country and is now more commonly associated with gram-negative organisms. Antibiotic resistance is increasing alarmingly, producing Multidrug-resistant pathogens upto 62% in our study.