Pleural Infection: Contemporary Microbiology Completing the Picture

We appreciate the opportunity to respond to the letter by Musher et al. [1] in which they critically assess our investigation on the microbiology of community-acquired oral-type pleural infections (OPIs).Unfortunately, they seem to ignore that we are addressing a very specific group of pleural infections and substantiate their criticisms by referring to publications inadequate to the task.The 1972 study by Bartlett and Finegold described anaerobic empyema exclusively [2].The 1974 study by Bartlett et al. excluded patients that had received antibiotics [3].Neither study distinguished between community-acquired and hospital-acquired infections and their findings are not directly comparable to ours.The referred studies were performed prior to the advent of next-generation sequencing (NGS).NGS has exposed the inadequacy of culture for describing complex bacterial infections, in particular those involving anaerobic bacteria or if patients have received antibiotics prior to sample collection.Pleural infections are often complex, frequently contain anaerobes and many patients have received antibiotics before sample collection.For pleural infections, studies using NGS report that culture recovered 10-16% of species present and that 50-78% of samples positive by NGS remained culture-negative [4][5][6].