Pleural infection, necrotising pneumonia and lung abscess

Therapeutic choices should be evaluated individually and shared in a multidisciplinary team. N Antibiotics remain the mainstay of treatment. N Chest drain with fibrinolysis is the preferred primary therapy in empyema; VATS should be reserved for use in patients refractory to medical treatment. N The long-term outcome for children with complicated pneumonia and no predisposing conditions is usually good. continuum, but classically it has been divided into three stages according to the evolution of the inflammatory process: exudative (simple parapneumonic effusion), fibropurulent (complicated parapneumonic effusion) and, eventually, overt pus in the pleural space (empyema). A simple parapneumonic effusion (PPE) is present in up to 40% of community-acquired pneumonia (CAP) and more than half of cases may complicate further. In our setting, the term of empyema is used generically to describe an advanced stage of PPE. Evidence suggests that the incidence of pleural empyema has increased in many countries over the past few years. The reasons for this dramatic increase are not known, but possibilities include changing bacterial resistance and virulence, introduction of the pneumococcal vaccination, adjustments to primary care antibiotic prescribing practices and referral patterns.