ObjectData on the characteristics and related factors of fungal empyema thoracis (FET) are limited. Our aim is to investigate the clinical characteristics and related factors of FET.MethodsWe conducted a retrospective study of patients with positive culture from pleural effusion who were admitted to the First Affiliated Hospital of Soochow University between January 2007 and January 2018. The clinical and laboratory characteristics of all study participants were collected. Logistic regression models were used to assess the related factors of FET.ResultsThere were 30 patients diagnosed with FET. The median age of patients with FET was 62.7 years old and 24 (80.0%) were male. The most frequent pathogens of FET were Candida albicans (55.9%). Diabetes mellitus (23.3% vs. 7.9%, P = 0.019) and upper gastrointestinal tract perforation or rupture (20.0% vs. 2.1%, P < 0.001) were associated with increased risk of FET. The adjusted odds ratios (95% confident interval) were 3.11 (1.02–9.56) for diabetes mellitus and 12.71 (3.47–46.55) for upper gastrointestinal tract perforation or rupture. There were 10 deaths (33.3%) among FET patients after one-year of follow-up.ConclusionsDiabetes mellitus and upper gastrointestinal tract perforation or rupture were associated with increased risk of FET.