Understanding empyema in Qatar: Microbiological profiles, clinical outcomes, and targeted treatment through a retrospective analysis.

Introduction: Empyema, characterized by the accumulation of pus in the pleural space, poses a significant medical challenge with diverse complications. This study aims to provide a comprehensive overview of the epidemiology, microbiological spectrum, management strategies, and outcomes of empyema patients in Qatar. Methods: We conducted a comprehensive review of electronic medical records from all hospitals affiliated with Hamad Medical Corporation, the national healthcare system of Qatar, for patients aged 18 years and older diagnosed with empyema between January 1, 2015, and December 31, 2019. Results: Seventy-five empyema cases were reviewed, predominantly male (89.3%) with a mean age of 44 years. Common comorbidities included diabetes mellitus (30.7%) and a history of malignancy (20%). Pleural fluid was universally exudative, with turbidity in (55.4%) and blood staining in (16.9%). Streptococcus (38.7%) and Gram-negative bacteria (29.3%) were the predominant pathogens. All patients received antibiotics, with chest tube insertion as the primary intervention in 74.6%. Video-Assisted Thoracoscopic Surgery (VATS) was performed in 24% and medical thoracoscopy in 1.3%. The mortality rate was significant at 18.6%. Univariate and multivariate analyses indicated that a prior history of pneumonia (P = 0.004), pleural effusion/empyema (P = 0.024), and malignancy (P < 0.036) were significant predictors of mortality. Conclusion: Streptococci were identified as the predominant pathogen in empyema cases in Qatar, with Diabetes Mellitus being the most common comorbidity. Early antibiotic therapy and chest tube insertion were key to effective management, often reducing the need for surgical interventions. Despite this, mortality remains a significant concern.