EMPYEMA-THORACIS - MEDICAL ASPECTS OF EVALUATION AND TREATMENT

Empyema thoracis is a disease that, despite centuries of study, still causes significant morbidity and mortality. Sixty-five cases were seen at Brooke Army Medical Center over an 8-year period (March 1, 1985, t hrough March 1, 1993). The majority of the patients were men, older th an 50 years of ape, with significant underlying diseases. Pneumonia re mains the most common single proximate cause of empyema. Gram-positive cocci are the most frequently isolated organisms; however, empyemas d ue to gramnegative organisms and anaerobes are associated with higher mortality. Pleural fluid gram stains proved to be an accurate but negl ected diagnostic tool in guiding initial therapy. The choice of antibi otics seemed to have no discernible impact on mortality. Closed tube t horacostomy was the initial method of drainage in most patients and ha d an overall success rate of 50%. Empyemas that could not be effective ly drained by a single chest tube were unlikely to be drained by addit ional closed maneuvers. There was an overall 22% case-fatality rate wi th most deaths related to our inability to eradicate the empyema.