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Respiratory: Chronic Infections > Empyema > Flashcards

Flashcards in Empyema Deck (18)
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1

what is it?

when a pleural effusion becomes infected, you get an empyema

2

how common are they?

effusions commonly occur with pneumonia and complicate around one-third to a half of all CAP cases

the majority of these are simple exudative effusions but empyema may also develop

3

what is the mortality like?

they have a high mortality
as high as severe pneumonia

>20% of all patients with empyema will die

4

which gram positive organisms cause empyema?

strep milleri

staph aureus - usually operative or nosocomial

5

who gets staph aureus empyema?

immunocompromised

6

what gram negative organisms cause empyema?

e.coli

pseudomonas

haem influenzae

klebsiella

7

which group of organisms are particularly bad news in pleural collection?

gram negative

8

when would you get anaerobes causing empyema?

in 13% of cases

usually in severe pneumonia or poor dental hygiene

9

what are the early indications of empyema?

slow to resolve pneumonia and ongoing fever

rising or persistently elevated inflammatory markers, despite appropriate antibiotic therapy

10

what investigations should be done?

CXR

thoracocentesis should be performed to make a diagnosis

ultrasound guided biopsy of fluid

11

what signs would you look for on a CXR?

D sign - pleura splits under high pressure - suggestive of empyema

12

when is a lateral CXR particularly useful?

in small diaphragmatic collections

13

what tests would be done on the fluid from ultrasound?

sent for gra stain, culture, fluid protein, glucose and LDH

14

what criteria can be applied to assess whether the effusion is transudative or exudative?

light's

15

what pH indicates empyema?

16

what treatment should be given ?

fluid should be urgently drained

IV antibiotics

oral antibiotics

the duration of antibiotic administration will usually need to be extended

thoracic surgery if severe

17

what IV antibiotics would be given?

broad spectrum

amoxicillin and metronidazole

18

what oral antibiotics would be given?

directed towards cultures bacteria for at least 14 days