What are the causes of secondary infection in hemothorax?

From the Guidelines

Secondary infections in hemothorax are primarily caused by retained hemothorax, which is a risk factor for developing pneumonia and empyema, alongside pathological contact with the outside environment in penetrating trauma. The causes of secondary infection in hemothorax can be attributed to several factors, including:

• Retained hemothorax, which creates an ideal environment for bacterial growth 1
• Contamination during chest trauma or procedures, such as tube thoracostomy 1
• Healthcare-associated pathogens, with Staphylococcus aureus being responsible for 35–75% of subsequent infections 1
• Delayed drainage of the hemothorax, inadequate initial debridement of contaminated wounds, and prolonged chest tube placement 1
• Compromised immune status of the patient, such as in elderly or frail patients 1
• Hospital-acquired infections during invasive procedures, such as thoracentesis or chest tube placement, if strict aseptic technique isn't maintained 1
• Pre-existing lung disease, diabetes, or malnutrition, which can increase the risk of infection 1 Prevention strategies, including prompt and complete evacuation of blood from the pleural space, proper wound care, and appropriate antibiotic prophylaxis, are essential to reduce the risk of secondary infection in hemothorax. Additionally, minimizing the duration of invasive devices and early recognition and treatment of infected hemothorax with appropriate antibiotics and drainage procedures can help prevent progression to empyema or sepsis 1.

From the Research

Causes of Secondary Infection in Hemothorax

• Secondary infection in hemothorax can occur due to various factors, including:
  • Introduction of bacteria or fungi into the pleural cavity through trauma, surgery, or other means 2, 3
  • Presence of underlying diseases or immunocompromising conditions, which can increase the risk of infection 2
  • Development of empyema or other complications, such as retained hemothorax or fibrothorax, which can provide a fertile ground for infection 4, 5
• Specific causes of secondary infection in hemothorax include:
  • Bacterial infections, such as those caused by Staphylococcus aureus, aerobic gram-negative bacilli, or anaerobic bacteria 3
  • Fungal infections, such as those caused by Candida species, Torulopsis glabrata, or Aspergillus species 2
• The risk of secondary infection in hemothorax can be increased by factors such as:
  • Delayed or inadequate treatment of the initial hemothorax 4, 5
  • Presence of foreign bodies or debris in the pleural cavity 3
  • Use of broad-spectrum antibiotics, which can disrupt the normal flora and increase the risk of infection with resistant organisms 3

Risk Factors for Secondary Infection

• Patients with underlying diseases or immunocompromising conditions are at increased risk of developing secondary infection in hemothorax 2
• Patients who have undergone surgery or have had trauma to the chest are also at increased risk 4, 5
• Patients with retained hemothorax or other complications are at higher risk of developing secondary infection 4, 5

Prevention and Treatment

• Prevention of secondary infection in hemothorax involves prompt and adequate treatment of the initial hemothorax, as well as measures to prevent introduction of bacteria or fungi into the pleural cavity 4, 5
• Treatment of secondary infection in hemothorax typically involves antibiotics or antifungal medications, as well as drainage of the pleural cavity and removal of any foreign bodies or debris 2, 3