From the Guidelines
Empyema is a condition characterized by the accumulation of pus in the pleural space, often as a result of a bacterial infection, and can lead to significant morbidity and mortality if not managed promptly and effectively. The management of empyema involves the use of antibiotics, with the choice of antibiotic guided by bacterial culture results or, in the absence of positive culture results, covering community-acquired bacterial pathogens and anaerobic organisms 1. Hospital-acquired empyema requires broader spectrum antibiotic cover. The use of chest tube drainage is also crucial in the management of empyema, with patients with frankly purulent or turbid/cloudy pleural fluid on sampling requiring prompt pleural space chest tube drainage 1.
The decision to use chest tube drainage should be based on the presence of organisms identified by Gram stain or culture from non-purulent pleural fluid samples, pleural fluid pH, and clinical progress 1. A pleural fluid pH of less than 7.2 indicates the need for chest tube drainage. The management of empyema should be individualized, taking into account the patient's clinical condition, the presence of any underlying diseases, and the likelihood of spontaneous resolution of the effusion.
Key points in the management of empyema include:
- The use of antibiotics, with the choice of antibiotic guided by bacterial culture results or, in the absence of positive culture results, covering community-acquired bacterial pathogens and anaerobic organisms
- The use of chest tube drainage, with patients with frankly purulent or turbid/cloudy pleural fluid on sampling requiring prompt pleural space chest tube drainage
- The decision to use chest tube drainage should be based on the presence of organisms identified by Gram stain or culture from non-purulent pleural fluid samples, pleural fluid pH, and clinical progress
- A pleural fluid pH of less than 7.2 indicates the need for chest tube drainage
- The management of empyema should be individualized, taking into account the patient's clinical condition, the presence of any underlying diseases, and the likelihood of spontaneous resolution of the effusion 1.
From the Research
Definition of Empyema
- Empyema is an infection of the pleural space, which is a common clinical problem with an increasing incidence 2, 3.
- It affects up to 65,000 patients annually in the United States, and its management involves a range of therapeutic options, including thoracentesis, chest tube drainage, and surgical interventions such as video-assisted thoracic surgery (VATS) or thoracotomy 2, 3.
Characteristics of Empyema
- Empyema is typically characterized by the accumulation of pus in the pleural space, which can lead to respiratory symptoms and other complications 2, 3.
- The condition can be community-acquired or nosocomial, and the choice of antibiotics depends on the source of the infection 2.
- Culture results may not always reflect the full disease process, and antibiotics alone are rarely successful in treating empyema 2.
Treatment of Empyema
- Early drainage with or without intrapleural fibrinolytics is usually required to treat empyema, and surgical decortication may be necessary in some cases 2, 3.
- The treatment outcomes, including success rates, readmission, reintervention, and mortality, can vary depending on the definitive treatment used, such as chest tube drainage, VATS decortication and drainage, or open decortication and drainage 3.
- Antibiotic levels in empyemic pleural fluid can also vary, with some antibiotics penetrating more easily into the infected pleural space than others 4.