TREATING EMPYEMA WITHOUT SURGERY

Most cases of empyema are caused by pneumococcal, staphylococcal aerob ic gram-negative, or anaerobic pathogens that gain access to pleural c avities during pneumonia, thoracic surgery, or trauma. The elderly and debilitated are at greatest risk. Mast infected pleural collections e volve through exudative, fibrinopurulent, and organizational stages, e ach having its own characteristics. Exudative stage parapneumonic effu sion commonly resolves with antimicrobial therapy alone, whereas fibri nopurulent parapneumonic effusion invariably requires drainage in addi tion to use of antibiotics. In the final, organizational stage, surgic al intervention is almost always necessary for successful eradication of infection.