Clinical characteristics and outcomes of pleural empyema in Southern Tunisia

Aim of the study: Describe clinical characteristics, treatment and evolution of thoracic empyema. Methods: A retrospective review was performed of all adult patients admitted to department of respiratory medicine of Sfax between January 2007 and December 2014 with the diagnosis of empyema. Results: Empyema was diagnosed in 42 patients: 34 men and 8 women. Mean age was 48 years. Lung disease was found in 8 patients, two with COPD ,one with lung cancer, and five patients with (tuberculosis sequelae, asthma ….) . An extra pulmonary pathology was found in 19 patients (chronic renal failure, diabetes, hypothyroidism, neoplasia...). Chest pain and fever were the major presenting symptoms (87%). Streptococcus constellatus (n=3), Streptococcus pneumoniae (n=5) and Klebsiella pneumonia (n=2) were the commonest organism isolated from blood and pleural fluid cultures.In all cases, treatment included an antibiotic use and a respiratory physiotherapy. The thoracentesis were performed in 27 patients and represented the only local action in 13 cases (30.9%). In addition to antibiotic therapy, initial treatment included chest tube drainage in 29 cases (69%) and surgical treatment in two cases. Pleural sequelae were noted in 16 patients with relapses in two others. Fibrinolysis was used in six cases because of multiloculations. Conclusion: Pleural empyema is still associated with considerable morbidity and mortality. The combination of antibiotic therapy and local treatment is the goldstandard. Multiloculation is not a contraindication to an initial trial of chest tube drainage or fibrinolytic therapy.