Sources of empyema are defined in Table 1. Contiguous spread of infection was defined in patients who had adjacent infection, such as esophageal rupture, pneumonia, mediastinitis, paraspinal abscess, or subdiaphragmatic liver abscess. Recurrent empyema was defined as culture-proven Candida infection occurring after apparent clinical resolution of an initial Candida empyema. Persistent empyema was defined as infection continuing for ≥5 days after appropriate source control, for which Candida was reisolated on culture from a pleural sample. Appropriate source control was defined as adequate drainage or surgical removal of infected material and correction of underlying pathology (eg, surgical repair of perforation or leak). Treatment was defined as receipt of a systemic antifungal agent for >48 hours. Combination therapy was defined as receipt of ≥2 classes of systemic antifungal agents (amphotericin B, azole, or echinocandin).

Classification of Sources of Candida Empyema

Abbreviations: GI, gastrointestinal.

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