The American Association for Thoracic Surgery consensus guidelines for the management of empyema

Abstract

The study objective was to establish The American Association for Thoracic Surgery (AATS) evidence-based guidelines for the management of empyema.

Intrapleural streptokinase is effective and safe for children with multi‐loculated empyema regardless of the time from disease onset

“…The median and interquartile range (IQR) age was 37 (16–72) months and 52 (22%) were younger than 12 months old. The median (IQR) duration of symptoms at presentation was 13.5 days. Over one‐sixth (41/236) had symptom duration of more than 28 days.…”

“…In contrast, the joint guidelines of the Paediatric Infectious Diseases Society and the Infectious Diseases Society of America, recommend tube drainage with, or without, fibrinolytic therapy, depending on the size of empyema . The American Association of Thoracic Surgery guidelines do not emphasise the use of intrapleural fibrinolytics .…”

Current State of Empyema Management

“…Empyema is a collection of purulent fluid in the pleural space that can occur with pneumonia or secondary to thoracic surgery or chest injury, affecting up to 65,000 patients annually at an estimated cost of 500 million dollars [1], with a mortality of approximately 15% [2]. Empyema evolves through exudative, fibrinopurulent, and organized phases over the course of 3–6 weeks.…”

Two vs. three weeks of treatment with amoxicillin-clavulanate for stabilized community-acquired complicated parapneumonic effusions. A preliminary non-inferiority, double-blind, randomized, controlled trial

“…The 2010 British Thoracic Society guideline for the management of pleural infections recognized that, despite the lack of evidence on this issue, antibiotics are often continued for 3 weeks [12]. More recently, the American Association of Thoracic Surgery recommended a minimum of 2 weeks of antibacterial therapy from the time of drainage and defervescence, based on expert opinion and standard of care [13]. In a recent retrospective review of 91 patients with empyema, of whom 90% underwent a thoracic surgical intervention, the median length of antimicrobial therapy was 27 (IQR 15-31) days [14].…”