Empyema

The majority of patients will be discharged from the hospital on oral antibiotics. These patients should be followed up in 2 to 4 weeks. Measurement of the C-reactive protein and white blood cell counts can help to assess the response to antibiotics and the required length of treatment.

Some patients (e.g., those who are not surgical candidates, or have an empyema which cannot be easily drained or a trapped lung) may require indefinite antibiotic treatment for chronic pleural infection.

A repeat chest x-ray (CXR) should be taken 4 to 6 weeks after discharge. Although invariably abnormal at discharge, most CXR changes resolve within 3 to 6 months with some residual pleural thickening.

Some patients develop restrictive pulmonary function as a result of residual pleural thickening following chest tube removal. This pleural thickening resolves in most patients within several months and the pulmonary function is usually near normal after 3 to 6 months. If reduced pulmonary function persists after 6 months and the patient is symptomatic, surgical decortication should be considered.

In children with Staphylococcus aureus or Pseudomonas aeruginosa empyema, an underlying cause such as immunodeficiency or cystic fibrosis should be considered.

All patients should be followed up until they have fully recovered.