Parapneumonic effusions and empyema

Parapneumonic effusions occur in up to 60% of patients hospitalized with community acquired pneumonia. Fortunately, the majority of these effusions follow an uncomplicated course responding to antibiotic therapy alone. An important subgroup of patients, however, follow a complicated course progressing to an empyema unless infected pleural fluid is drained. Decisions for drainage depend on host factors, the nature of the respiratory pathogen, and the extent of pleural inflammation and loculation. Staging of a parapneumonic effusion allows selection of a drainage procedure that will be most effective. Adjunctive therapies, such as intrapleural fibrinolysis, appear to contribute to resolution of pleural infection but more investigational data are needed to determine their specific role.