The clinical course and management of thoracic empyema

We report a prospective multi-centre study of the clinical course andhospital management of thoracic empyema in 119 patients (mean age 54.8).The commonest presenting symptom was malaise (75%), 55% were febrile; 31%were previously well with no predisposing condition. Initial treatmentswere antibiotics alone (5), needle aspirations (46), intercostal tubedrainage (61), rib resection (3) and decortication (4). Overall,intercostal drainage was used in 77 patients (16 failed aspirations),surgical rib resection in 24 (1 failed aspirations, 20 failed drainage),and surgical decortication in 28 (6 failed aspirations, 17 faileddrainage). Only 4 patients received intrapleural fibrinolytic agents.Aspiration and drainage were likely to fail if the empyema was >40%of the hemithorax. Median time from treatment start to discharge was:aspirations, 26 days; drainage, 23 days; resection 11 days; decortication,12 days. Overall 21 patients died (12 with empyema as the major cause); twohad been surgically treated. Mortality correlated with age, diabetes, heartfailure, and low serum albumin at admission. Infecting organisms,identified in 109 patients (92%) included anaerobes (37), Str.melleri (36), and Str. pneumoniae (28). Sixmonths after discharge, all but six survivors had regained their previoushealth.