Spectrum: Local Antimicrobial Stewardship, for Eastern Health

Empyema Drainage

Likely Organisms and Antimicrobial Regimen

Treatment Approach: Need for Drainage

Indications for drainage

  • pH < 7.2 or glucose < 50% of serum glucose

  • Positive gram stain or culture, or frank pus

  • Loculated collections, or thickened/enhancing pleura on imaging

  • Effusion causing significant respiratory compromise

Treatment Approach: Uncomplicated

Uncomplicated parapneumonic effusion

  • Typically resolve with treatment of pneumonia and do not require modification of pneumonia therapy provided patient clinically improving.

  • Follow with serial CXRs to significant improvement

Treatment Approach: Complicated/Empyema

Chest drainage can usually be done with 10-14Fr catheters and is less painful than larger thoracostomy tubes.

Flushing with 20cc saline q12h suggested to maintain patency.

If patient not improved at 48h consider CXR for confirmation of tube placement, and/or CT for tube placement and to identify undrained loculations.

Thoracic surgery consultation should be considered for all empyemas, and for patients who fail to improve with drainage.

Some will eventually require open or thorascopic drainage and debridement