Forty-one (6.8%) adult patients hospitalized with primary nontuberculous bacterial pneumonia over a four-year period had empyema on admission. Staphylococcus aureus was the most common causative microorganism isolated. In 64% of the cases of empyema complicating some underlying disease, gram-negative microorganisms were isolated. Empyema may be mistaken for pulmonary infarction or masked by congestive heart failure. Fever and a peripheral leukocytosis may not be present in patients with underlying conditions. Evidence is presented that various antibiotics, administered parenterally in high doses, can sterilize empyema fluid. Effective drainage of the empyema cavity is also essential. The temperature response after closed drainage is initiated gives an indication whether open drainage will be required.
Vianna NJ. Nontuberculous Bacterial Empyema in Patients With and Without Underlying Diseases. JAMA. 1971;215(1):69–75. doi:10.1001/jama.1971.03180140033005
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