From the Guidelines
Empyema is a serious infection characterized by the accumulation of pus in the pleural space, the area between the lungs and the chest wall, typically developing as a complication of pneumonia, chest trauma, surgery, or the spread of infection from elsewhere in the body. The condition presents with symptoms including fever, chest pain, shortness of breath, and productive cough. According to the BTS guidelines for the management of pleural infection 1, treatment usually involves a combination of antibiotics and drainage procedures.
Key Points
- Antibiotics commonly used include broad-spectrum options like piperacillin-tazobactam, meropenem, or combinations of ceftriaxone and metronidazole, typically administered intravenously for 2-6 weeks depending on severity.
- Drainage is essential and may be accomplished through thoracentesis (needle drainage), chest tube placement, or surgical interventions like video-assisted thoracoscopic surgery (VATS) or thoracotomy for more complex cases.
- The condition requires prompt treatment as untreated empyema can lead to serious complications including lung abscess, sepsis, or chronic pleural thickening that restricts lung function, with a mortality rate of up to 20% in some cases 2.
- The development of empyema relates to the body's inflammatory response to infection, where white blood cells accumulate in the pleural space, creating thick, purulent fluid that cannot be reabsorbed naturally.
Treatment Approach
The BTS guidelines 1 emphasize the importance of rapid evaluation and therapeutic intervention to reduce morbidity and mortality, as well as health care costs. The use of antibiotics and drainage procedures is crucial in the management of empyema, and the choice of treatment should be guided by the severity of the condition and the patient's overall health. In some cases, surgical intervention may be necessary to drain the pleural space and restore lung function.
From the Research
Definition of Empyema
- Empyema is a condition characterized by the accumulation of pus in the pleural space, which is the area between the lungs and the chest wall 3, 4, 5, 6, 7.
- It is often a complication of bacterial pneumonia, and can cause significant morbidity and mortality if left untreated 5, 6.
Characteristics of Empyema
- Empyema is typically associated with the presence of frank pus or a high bacterial load in the pleural fluid 3.
- The condition can be diagnosed using a combination of clinical, radiological, and laboratory tests, including chest X-rays, ultrasound, and pleural fluid analysis 4, 7.
- The treatment of empyema often involves a combination of antibiotics, chest tube drainage, and fibrinolytic therapy to break down adhesions and promote drainage 3, 4, 5, 6, 7.
Treatment Options for Empyema
- Intrapleural streptokinase is a commonly used fibrinolytic agent for the treatment of empyema, and has been shown to be effective in reducing the need for surgery and improving clinical outcomes 3, 4, 6.
- Other treatment options for empyema include video-assisted thoracoscopic surgery (VATS) and open thoracotomy with decortication, which may be necessary in cases where fibrinolytic therapy is unsuccessful or contraindicated 5, 7.
- The choice of treatment for empyema depends on a variety of factors, including the severity of the condition, the presence of underlying medical conditions, and the patient's overall health status 5, 6, 7.