Empyema

Diagnostic studies should be performed to identify the source of infection, causative pathogen, and any complications (e.g., abscess, empyema, infected intravascular catheter, etc). 

Fatty liver of pregnancy Placental abruption Preeclampsia/eclampsia Retained fetus syndrome Pulmonary syndrome syndrome Empyema Hyaline membrane disease... 

Outcome parameters for VAP, HAP, and HCAP are similar to those with CAP. Clinical improvement should occur within 48 to 72 hours of the start of therapy. If a patient is not responding to therapy, then, again, consider infectious and noninfectious reasons. Infectious explanations are the same as for CAP, but noninfectious reasons are not. They include atelectasis, acute respiratory distress syndrome (ARDS), pulmonary embolism or hemorrhage, cancer, empyema, or lung abscess. 

Empyema Pus in the pleural cavity, usually secondary to infection in the lung. 

Signs and Symptoms Pneumonia with or without bacteremia. Pulmonary abscesses, fluid (pleural effusion) and pus (empyema) in the chest cavity may occur. In acute cases pus is discharged from the nose. There are ulcers in the mucous membranes of the nose and possibly the pharynx. 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

It is used for peritonitis, sepsis, meningitis, cholangitis, empyema of the gaU bladder, pneumonia, lung abscesses, pyelonephritis, infections of the bones, joints, skin, soft tissues, abdominal and gynecological infections, and for infected wounds and bums. The main synonym of this drug is rocefm. 

It is used for severe bacterial infections peritonitis, sepsis, meningitis, osteomyelitis, endocarditis, pneumonia, pleural empyema, pulmonary abscess, purulent skin infections and soft tissue infections, and infections of the urinary tract caused by microorganisms that are sensitive to the drug. Synonyms of this drug are nebicine, obracine, and others. 

Do not treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis, or purulent or septic arthritis with an oral penicillin during the acute stage. 

Anaerobes Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess serious skin and soft tissue infections septicemia, intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal Gl tract) infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. 

Lower respiratory tract infections - Pneumonia, empyema, and lung abscess caused by Bacteroides sp. including the 6. fragilis group. 

Clindamycin can be administered orally with a high bioavailability. Also formulations for intravenous administration exist. Protein binding is about 90%. It is distributed throughout the body except the CNS. It shows excellent penetration in bone and in empyema and abscesses. It is metabolized in the liver and excreted in the bile. The elimination half-life is about 3 h. Adverse effects include gastrointestinal distress, skin rashes and decreased liver function. Pseudomembranous colitis is relatively frequently seen due to resistance of Clostridium difficile. 

Host factors reducing the in vivo activity of the drug o abscess or empyema... 

The spectrum of respiratory tract infections (RTI) can vary from the common cold to acute or chronic bronchitis to community-acquired pneumonia to nosocomial pneumonia and aspiration pneumonia to ventilator-associated pneumonia to chronic pneumonia (in cystic fibrosis, histoplasmosis, tuberculosis, etc.). Important complications are lung abscess and pleural empyema that will often need drainage and prolonged antimicrobial treatment (>6 weeks). 

X-ray should be performed to exclude empyema or lung abscess. 

Severe presumed bacterial infections (e.g. pneumonia, empyema, pyomyositis, bone or joint infection, meningitis,... 

For parenteral therapy, nafciUin and oxacillin offer comparable efficacy and antimicrobial spectra of activity. Although both drugs undergo hepatic metabolism, only nafcillin requires dose adjustment in patients with combined hepatic and renal insufficiency. Other pharmacokinetic data for nafcillin and oxacillin appear in Table 45.1. Indications for nafcillin or oxacillin include severe staphylococcal infections like cellulitis, empyema, endocarditis, osteomyelitis, pneumonia, septic arthritis, and toxic shock syndrome. 

Pleural empyema. Accumulation of a liquid inflammation product made up of leukocytes (pus) in a cavity of the lungs. Pleurisy. Inflammation of the pleura, with exudation into its cavity and on its surface. Pneumonia. Inflammation of the lungs with consolidation. 

Ioseliani GG, Meladze GD, Chkhetiia NSh et al (1980) Use of bacteriophage and antibiotics for prevention of acute postoperative empyema in chronic suppurative lung diseases. Grudnaia Khimrgiia (Russian Breast Surgery) 1 63-67... 

Empyema-like eosinophilic pleural effusion following the use of smoked crack cocaine has been reported (114). 

Strong DH, Westcott JY, Biller JA, Morrison JL, Effros RM, Maloney J. Eosinophilic empyema associated with crack cocaine use. Thorax 2003 58 823 1. 

Local sepsis (sinuses, ears, mastoids, scalp, nasopharynx) Subdural empyema Bacterial meningitis Dural arteriovenous fistula... 

Johnson, Caroline C., and Sydney M. Finegold. Pyogenic Bacterial Pneumonia, Lung Abscess, and Empyema. In Volume 1 Textbook of Respiratory Medicine. 2nd ed., John F. Murray and Jay A. Nadel, eds. Philadelphia W.B. Saunders Company, 1994. 

Empyema is treated according to the organism isolated and with aspiration and drainage. 

Haemophilus influenzae cefotaxime 2-3 g 6-8-hourly or chloramphenicol 100 mg/kg/d is given. Treatment should continue for 10 days after the temperature has settled. Subdural empyema, often presenting as persistent fever, is relatively common after haemophilus meningitis and may require surgical drainage. 

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