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[Pleural empyema in mechanically ventilated patients with pneumonia].

Abstract
Two males aged 41 and 32 years developed pneumonia which responded inadequately to antibiotic treatment and necessitated mechanical ventilation. It was only after surgical and digital opening, drainage of pus pockets and daily pleural lavage that the clinical picture improved. The microorganisms cultured from both patients included Streptococcus milleri, probably acquired by aspiration. Thoracic empyema as a complication of pneumonia is clinically recognised by lack of response to antimicrobial agents. For the diagnosis, ultrasonographic and CT imaging, followed by pleural puncture are used. Simple parapneumonic effusions are managed by drainage with or without rinsing with normal saline, while in advanced empyema, instillations with fibrinolytic agents have proved safe and effective. Sometimes, video-assisted thoracoscopic or conventional surgery is necessary to clear the pleural space, while in complicated cases, extensive surgical procedures are warranted.
AuthorsA J ten Hagen, T S van der Werf, J J Ligtenberg, J J Meuzelaar, A V Möller, J G Zijlstra
JournalNederlands tijdschrift voor geneeskunde (Ned Tijdschr Geneeskd) Vol. 143 Issue 5 Pg. 255-9 (Jan 30 1999) ISSN: 0028-2162 [Print] Netherlands
Vernacular TitlePleura-empyeem bij beademde patiënten met pneumonie.
PMID10086154 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Clindamycin
  • Streptokinase
Topics
  • Adult
  • Anti-Bacterial Agents (therapeutic use)
  • Clindamycin (therapeutic use)
  • Drainage
  • Drug Resistance, Microbial
  • Empyema, Pleural (diagnosis, etiology, therapy)
  • Humans
  • Male
  • Pleura (microbiology, surgery)
  • Pneumonia (complications, therapy)
  • Respiration, Artificial
  • Sepsis (therapy)
  • Streptococcal Infections (microbiology, therapy)
  • Streptokinase (therapeutic use)
  • Treatment Outcome

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