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Published on: November 10, 2023
Recent advances in parapneumonic effusion and empyema
Stephen J Chapman1, Robert J O Davies
1Oxford Pleural Diseases Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK. schapman@well.ox.ac.uk
Purpose Of Review:
Complicated parapneumonic effusion and empyema continue to account for significant morbidity and mortality, and uncertainties remain regarding their optimal management. This review describes recent advances in this field, as well as areas for future research.
Recent Findings:
Recent advances have addressed the pathogenesis, bacteriology, and treatment of pleural infection. Key areas for research in the development of empyema include the interplay between inflammatory and coagulation cascades and development of fibrosis within the pleural space. The varied bacteriology of empyema has been more clearly defined, and in particular the differences between community- and hospital-acquired infection highlighted. Studies of treatment have focused particularly on the roles of intrapleural fibrinolytics and surgery.
Summary:
Increased understanding of the pathogenesis of empyema may ultimately yield novel therapeutic targets. Comprehensive descriptions of the bacteriology of empyema aids antibiotic choice, and the use of intrapleural DNase shows promise in facilitating drainage of infected pleural fluid. Uncertainties remain, such as the role of intrapleural fibrinolytics and the optimal timing of surgical intervention.
Insights
Recent advances in managing complicated parapneumonic effusion and empyema offer new insights into pathogenesis and treatment. Further research is needed to clarify the roles of intrapleural fibrinolytics and surgical timing for optimal patient outcomes.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Thoracic Surgery
Background:
- Complicated parapneumonic effusion and empyema are significant causes of morbidity and mortality.
- Optimal management strategies for these pleural infections remain an area of active investigation.
Purpose of the Study:
- To review recent advancements in understanding and managing complicated parapneumonic effusion and empyema.
- To identify key areas for future research in pleural infection.
Main Methods:
- Literature review of recent studies on pleural infection.
- Analysis of advances in pathogenesis, bacteriology, and treatment of empyema.
Main Results:
- Advances in understanding empyema pathogenesis, including inflammatory and coagulation cascades.
- Clarification of empyema bacteriology, differentiating community- vs. hospital-acquired infections.
- Focus on intrapleural fibrinolytics and surgical interventions in treatment studies.
Conclusions:
- Enhanced understanding of empyema pathogenesis may lead to novel therapeutic targets.
- Detailed bacteriology aids antibiotic selection; intrapleural DNase shows promise for fluid drainage.
- Uncertainties persist regarding intrapleural fibrinolytics and optimal surgical timing.
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