Empyema Flashcards
what is it?
when a pleural effusion becomes infected, you get an empyema
how common are they?
effusions commonly occur with pneumonia and complicate around one-third to a half of all CAP cases
the majority of these are simple exudative effusions but empyema may also develop
what is the mortality like?
they have a high mortality
as high as severe pneumonia
> 20% of all patients with empyema will die
which gram positive organisms cause empyema?
strep milleri
staph aureus - usually operative or nosocomial
who gets staph aureus empyema?
immunocompromised
what gram negative organisms cause empyema?
e.coli
pseudomonas
haem influenzae
klebsiella
which group of organisms are particularly bad news in pleural collection?
gram negative
when would you get anaerobes causing empyema?
in 13% of cases
usually in severe pneumonia or poor dental hygiene
what are the early indications of empyema?
slow to resolve pneumonia and ongoing fever
rising or persistently elevated inflammatory markers, despite appropriate antibiotic therapy
what investigations should be done?
CXR
thoracocentesis should be performed to make a diagnosis
ultrasound guided biopsy of fluid
what signs would you look for on a CXR?
D sign - pleura splits under high pressure - suggestive of empyema
when is a lateral CXR particularly useful?
in small diaphragmatic collections
what tests would be done on the fluid from ultrasound?
sent for gra stain, culture, fluid protein, glucose and LDH
what criteria can be applied to assess whether the effusion is transudative or exudative?
light’s
what pH indicates empyema?
