General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 12, pp 1048–1055 | Cite as

Therapeutic strategy for acute pleural empyema: comparison between retrospective study and prospective study

  • Hitoshi SuzukiEmail author
  • Shin Shomura
  • Yasuhiro Sawada
  • Akira Shimamoto
  • Chiaki Kondo
  • Motoshi Takao
  • Hideto Shimpo
Original Article



The purpose of this study is to investigate the efficiency of therapeutic strategy for acute pleural empyema.


We retrospectively reviewed 121 acute empyema patients and evaluated the therapeutic strategy for acute pleural empyema. Then, we prospectively reviewed 114 acute pleural empyema patients based on the strategy.


The duration from onset to hospitalization in our hospital is statistically shorter, and the mortality and the rate of stage 3 empyema patients are lower in the prospective study group (PSG) than in the retrospective study group (RSG). Retrospective study and prospective study found that surgical group (SG) had more favorable outcomes than non-surgical group (NSG). Although antibiotic treatment duration, hospital stay, and entire mortality were comparable in NSG of both study groups, mortality of patients with PS grade 4 was significantly lower in PSG. SG in PSG had more favorable outcomes than that in RSG, such as antibiotic treatment duration, hospital stay, complication, and mortality.


The good outcomes may be mainly caused by shorter duration from onset to hospitalization and shorter duration from hospitalization to operation. Operative management is an effective procedure for selected patients, and it is important to refer for thoracic surgical consultation earlier.


Pleural empyema Retrospective study Prospective study Therapeutic strategy 



Performance status


Retrospective study group


Prospective study group


Surgical group


Non-surgical group


Incomplete pulmonary re-expansion


Complete pulmonary re-expansion


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.


  1. 1.
    Maskell NA, Batt S, Hedley EL, Davis CW, Gillespie SH, Davies RJ. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006;174:817–23.CrossRefGoogle Scholar
  2. 2.
    Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3(1):75–80.CrossRefGoogle Scholar
  3. 3.
    Davies HE, Davies RJ, Davies CW. BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65:41–53.Google Scholar
  4. 4.
    Farjah F, Symons RG, Krishnadasan B, Wood DE, Flum DR. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg. 2007;133:346–51.CrossRefGoogle Scholar
  5. 5.
    Nandeesh M, Sharathchandra BJ, Thrishuli PB. ICD versus VATS as primary treatment in fibrinopurulent stage of empyema thoracis. J Clin Diagn Res. 2013;7:2855–8.Google Scholar
  6. 6.
    Bilgin M, Akcali Y, Oguzkaya F. Benefits of early aggressive management of empyema thoracis. ANZ J Surg. 2006;76:120–2.CrossRefGoogle Scholar
  7. 7.
    Baek JH, Lee YU, Lee SS, Lee JH, Lee JC, Kim MS. Early aggressive surgical treatment of multiloculated empyema. Korean J Thorac Cardiovasc Surg. 2017;50:202–6.CrossRefGoogle Scholar
  8. 8.
    Kullar R, Davis SL, Levine DP, Rybak MJ. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: support for consensus guidelines suggested targets. Clin Infect Dis. 2011;52:975–81.CrossRefGoogle Scholar
  9. 9.
    Delaney JA, Schneider-Lindner V, Brassard P, Suissa S. Mortality after infection with methicillin-resistant Staphylococcus aureus (MRSA) diagnosed in the community. BMC Med. 2008;6:2. Scholar
  10. 10.
    Sato N, Hoshi E, Aoyama K, Murai K, Ikeya T, Sugita Y, et al. Thoracoscopic treatment of patients with acute bacterial empyema. J Jpn Soc Resp Endosc. 2003;25:279–83.Google Scholar
  11. 11.
    Rodeheaver GT. Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Kane D (eds) Chronic wound care: a clinical source book for healthcare professionals. 2nd edn. Health Management Publications, Inc, Wayne; 1997, pp 97–108.Google Scholar
  12. 12.
    Gossot D, Stern JB, Galetta D, Debrosse D, Girard P, Caliandro R, et al. Thoracoscopic management of postpneumonectomy empyema. Ann Thorac Surg. 2004;78:273–6.CrossRefGoogle Scholar
  13. 13.
    Mennander A, Laurikka J, Kuukasjärvi P, Tarkka M. Continuous pleural lavage may decrease postoperative morbidity in patients undergoing thoracotomy for stage 2 thoracic empyema. Eur J Cardiothorac Surg. 2005;27:32–4.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryMie Prefectural General Medical CenterMieJapan
  2. 2.Department of Thoracic and Cardiovascular Surgery, Graduate School of MedicineMie UniversityMieJapan

Personalised recommendations