Recognize
Frank pus establishes empyema. Pleural pH, glucose, LDH, Gram stain/culture and imaging help identify complicated parapneumonic effusions requiring drainage; send fluid in blood-culture bottles to improve microbiologic yield.
respiratory
Pleural Infection / Empyema — Bedside Problem
Diagnosis and source control of complicated parapneumonic effusion and empyema with drainage, tPA/DNase and surgical escalation
Act
Select therapy based on community versus hospital acquisition, aspiration risk and local resistance, then narrow to microbiology. Antibiotic duration is individualized to source control and clinical/radiologic response.
Escalate
Pleural sepsis can perpetuate shock and ventilator dependence. Re-image when the patient fails to improve and look for tube obstruction, loculation or alternative infection sources.
Evidence status
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