Empyema: Difference between revisions
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*Abx | *Abx | ||
**Piperacillin-tazobactam 3.375-4.5gm q6hr IV or imipenem 0.5-1gm q6hr | **Piperacillin-tazobactam 3.375-4.5gm q6hr IV or imipenem 0.5-1gm q6hr | ||
**Consider adding vancomycin if pt at risk for MRSA | **Consider adding [[vancomycin]] if pt at risk for MRSA | ||
==See Also== | ==See Also== |
Revision as of 07:51, 3 March 2014
Background
- Pleural space infections with positive Gram stain or culture OR parapneumonic effusions without pleural fluid sampling
- 3 stages
- 1. Exudative
- Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
- 2. Fibrinopurulent
- Loculations develop making resolution w/ single chest tube drainage unlikely
- 3. Organizational
- Takes several weeks to develop; "pleural peel" restricts lung expansion
- 1. Exudative
Causes
- Pneumonia
- Complications of chest or abdominal trauma
- Esophageal perforation
- Extension from lung abscess
- Osteomyelitis or other near pleural infections
- Hemothorax, chylothorax, or hydrothorax that becomes infected
Diagnosis
- Usually preceded by PNA
- Suspect if symptoms of PNA do not resolve
- Diagnostic criteria
- Aspiration of purulent material on thoracentesis and at least 1 of the following:
- 1. Positive Gram stain or culture
- 2. Pleural fluid glucose <40
- 3. pH <7.1
- 4. LDH >1000
- Aspiration of purulent material on thoracentesis and at least 1 of the following:
Treatment
- Treat underlying disease
- Perform thoracentesis versus chest tube drainage if e/o respiratory distress
- Abx
- Piperacillin-tazobactam 3.375-4.5gm q6hr IV or imipenem 0.5-1gm q6hr
- Consider adding vancomycin if pt at risk for MRSA
See Also
Source
- Tintinalli