What is new in pleural infections?

The field of pleural medicine has seen significant advances in recent years, shaping both the current and future evaluation and treatment of pleural infection. Recent studies have demonstrated a continued rise in the prevalence of pleural infection and provide a more refined understanding of the risk factors associated with its occurrence. The increased use of point-of-care ultrasound and the identification of computed tomography markers have enhanced and expedited initial evaluation. Novel microbiological techniques are expanding our understanding of the diversity of causative pathogens and disease mechanisms, with potential implications for diagnostic strategies and antibiotic selection. Emerging studies are also exploring the feasibility of shorter courses of antibiotics. Meanwhile, novel blood and pleural fluid biomarkers are being increasingly studied for both diagnosis and prognostication. Furthermore, accumulating evidence on risk stratification is increasingly being published and used in clinical settings. The specific role, optimal sequence and patient selection for intrapleural enzyme therapy, surgery, and medical thoracoscopy is enabling a more personalised approach to treatment and may improve patient outcomes. These and other developments are discussed in this review, which presents a state-of-the-art overview of pleural infection management from the clinician's perspective, highlighting recent and anticipated advances.