Chapter

Pleural infections

Clare Hooper and Nick Maskell

in Acute Respiratory Infections

Published on behalf of Oxford University Press

Published in print July 2012 | ISBN: 9780199588084
Published online October 2012 | e-ISBN: 9780191739668 | DOI: http://dx.doi.org/10.1093/med/9780199588084.003.0006

Series: Oxford Respiratory Medicine Library

Pleural infections

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Key points

Pleural infection is associated with a mortality rate of 15–20% - The bacteriology of community acquired pleural infection is distinct from that of community acquired pneumonia. Empirical antibiotics should always cover penicillin resistant aerobes and anaerobic organisms - Hospital acquired pleural infection has a worse prognosis than community acquired pleural infection and is most often due to MRSA or gram negative bacteria - All parapneumonic effusions >1cm in depth should be sampled and fluid pH measured unless frank pus is obtained - No presenting clinical, biochemical or radiological features accurately predict outcome or the need for surgical intervention, so that early intravenous antibiotics and chest tube drainage with assiduous clinical monitoring for primary treatment failure should be applied to every patient - Mortality is greater in the elderly and those with co-morbid illnesses. Therefore, they in particular should be considered early for limited surgical drainage procedures if failing to respond to medical management - Follow up for at least 3 months is mandatory to detect the minority of patients who relapse with pleural sepsis or persistent breathlessness due to pleural thickening.

Chapter.  3542 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology

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