[Treatment of advanced pleural empyema]

Despite the widespread availability of antibiotics and a declining incidence, pleural empyema still represents a serious intrathoracic disease often requiring surgical treatment for successful therapy. 104 patients with complicated pleural empyema were treated at our hospital between June 1991 and June 1997. In this retrospective study the main causes for pleural empyema were pneumonia in 41.3% and direct inoculation of the pleural space by major and minor thoracic surgery in 30.8%. Further diseases leading to an empyma of the pleural space were oesophageal perforation (11.5%), ARDS (8.7%) and hematogenous infection (7.7%). Eighty-four patients (80.8%) underwent surgery, of whom 17 patients required multiple operations. Conservative therapy with chest tube drainage and systemic application of tested antibiotics was performed in 20 patients. The overall mortality of our patients was 19.2%, but depending on the underlying disease differed considerably between 8.3% and 44.4%. Multiple operations caused by persisting empyema had a significantly higher mortality rate (58.8%) than single operations (10.5%).