Empyema management: A cohort study evaluating antimicrobial therapy

Kate Birkenkamp, John C. O'Horo, Rahul Kashyap, Ben Kloesel, Brian D. Lahr, Craig E. Daniels, Francis C. Nichols, Larry M. Baddour

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Objectives: Empyemas require aggressive antimicrobial and surgical management. However, the specifics of antimicrobial therapy have not been studied in clinical trials. The present study examines management and outcomes among a cohort of patients with empyema cared for in a tertiary-care referral hospital over a decade. Methods: We retrospectively identified patients hospitalized with empyema from January 2000 through December 2010 at one institution. Patient demographics, laboratory findings, treatments, and patient outcomes were abstracted using a standard form. Data were summarized with standard descriptive statistics. Results: A total of 91 patients were identified. The predominant organisms were viridans group streptococci, which were isolated in 64% of cases with cultures. The median length of hospitalization was 9 days. Length of antimicrobial therapy from time of source control was variable, with a median (interquartile range) duration of 27 (15-31) days. Of note, longer courses of parenteral, but not oral, therapy were associated with fewer cases of clinical failure. Conclusions: This descriptive analysis demonstrated a higher rate of viridans group streptococci than expected. Three weeks of therapy was generally adequate and prevented clinical failure, but further study is needed with a much larger cohort to better define the optimal drug regimen, route, and duration of antimicrobial therapy for empyema.

Original languageEnglish (US)
Pages (from-to)537-543
Number of pages7
JournalJournal of Infection
Issue number5
StatePublished - May 1 2016

Bibliographical note

Publisher Copyright:
© 2016 The British Infection Association.


  • Empyema
  • Parapneumonic effusion
  • Pleural effusion
  • Pleural infection


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