Empyema:
- Empyema is a common complication of bacterial CAP. The common pathogens causing empyema include Pneumococcus, S. aureus, S. pyogenes and sometimes Klebsiella or other gram negative bacilli. It should be suspected if there is persistent fever, leukocytosis and effusion on the CXR. USG can be done to confirm the diagnosis. The pleural fluid should be tapped and if it is purulent/ has organisms on the gram stain or culture, empyema is confirmed. It should also be suspected in complicated para-pneumonic effusions (pH < 7.0/ sugar <40 mg/dl/ LDH> 1000 IU/l/ lactate > 45 mg/dl).
- Drainage of the infected fluid is paramount and can be done by chest tube with or without fibrinolytics. VATS or thoracotomy may be needed in certain cases with organized empyema.