Epidemiology of pleural infections in Taiwan from 1997 through 2008

ABSTRACT Background and objective: Population‐based data on pleural infections are limited. This study describes the temporal trends in the incidence, management and outcomes of pleural infections in Taiwan. Methods: The Taiwan National Health Insurance Research Database was used to analyse data on 26 385 patients with a first episode of pleural infection between 1997 and 2008. Results: During the study period, the median age of the patients increased from 60 to 65 years. The majority of patients were men (75%); this proportion remained constant over time. The standardized annual incidence of pleural infection increased from 5.2 per 100 000 in 1997 and reached a plateau of 8.4 to 9.6 per 100 000 between 2002 and 2008. Over time, there was an increase in the use of computed tomography (from 47.3% in 1997–1998 to 59.4% in 2007–2008), pigtail catheters (from 1.5% to 18.9%), fibrinolytics (from 0.9% to 9.3%) and surgery (from 27.7% to 33.6%), to treat pleural infections. Furthermore, the use of life‐support resources, including haemodialysis, mechanical ventilation and intensive care, also increased by 3.1%, 11.0% and 12.8%, respectively. Median hospital charges per patient increased by 63.6% over the 12 years. Although the proportion of patients with organ dysfunction (i.e. severe sepsis) increased from 26.5% to 47.7%, 30‐day mortality decreased from 15.0% to 13.1% (P‐value for trend = 0.001). Conclusions: These findings suggest that advances in the management of pleural infections and subsequent severe sepsis may have led to a reduction in the risk of short‐term mortality in Taiwan. Pleural infections have changed over time, with respect to incidence, management and outcomes. In Taiwan, the incidence of pleural infection reached a plateau in recent years, resource utilization and hospital charges increased substantially and short‐term mortality decreased over time, despite an increase in the proportions of older and sicker patients.