Materiały źródłowe

• #1 Empyema: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24269-empyema

  Empyema typically develops when an infection spreads from your lungs to the pleural space. […] The most common cause of empyema is pneumonia. Other causes include: Tuberculosis, Lung abscess, Chest surgery, Chest injuries or trauma.

• #1 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  Defined as a collection of pus in the thoracic cavity arising from infection in the pleural space, empyema is most commonly caused by bacterial pneumonia and the resulting accumulation of fluid (parapneumonic effusion) in the pleural space. Approximately 20% to 40% of patients who are hospitalized for pneumonia in the United States (US) develop a parapneumonic effusion, and approximately 5% to 10% of them develop empyema. In addition to parapneumonic effusion, other causes of empyema include thoracic surgery, chest trauma, lung abscess, cervical or thoracic spine infections, bronchogenic carcinoma, and esophageal rupture. Patients are at an increased risk for empyema if they are of advanced age or have one of the following conditions: diabetes, immunosuppression, cardiovascular disease, liver cirrhosis, gastric acid reflux, and alcohol and intravenous drug abuse. Studies have shown that community-acquired pleural infections most commonly arise from aerobic Streptococcus (Streptococcus pneumoniae, S intermedius, and other streptococcal species), Staphylococcus, and gram-negative bacteria (Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae); however, hospital-acquired infections most frequently arise from methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria (pseudomonas and enterobacteriaceae).

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Empyema.aspx

  Empyema occurs through either bacterial or fungal infections. […] Bacterial infections are the most common and there are various types of bacteria that can cause empyema. However, the most common is the streptococcus family, in which the usual causatives are Streptococcus Pneumoniae and Streptococcus Aureus. […] Pneumonia is the most common cause of empyema. It is caused by a bacterial infection in the lungs. Empyema usually forms when pneumonia does not respond to treatment completely. […] Fungal empyema is rare and is linked to a higher mortality rate. The Candida species is the most commonly seen fungus associated with this type of infection. […] A rare possibility of bacterial infections is seen through the process of pulmonary aspirations (inhaling food, saliva, or stomach acid into lungs). Tuberculosis can also cause infections leading to empyema.

• #1 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Many pleural space infections present as complications from community- or hospital-acquired pneumonia. Other causes include penetrating chest trauma, thoracic surgery, esophageal rupture, pulmonary tuberculosis, lung abscess, bronchiectasis, subphrenic abscess, and osteomyelitis of ribs. Independent risk factors for empyema development include: Younger than 60, Poor oral hygiene, Disorders with a predisposition to aspiration (seizure, alcohol use disorder, central nervous system disease), Intravenous drug misuse, Diabetes, Cardiovascular disease, Liver cirrhosis, Other immunocompromised states (eg, human immunodeficiency virus infection or malignancy). […] Aerobic Staphylococcus and Streptococcus species and gram-negative bacteria, including Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae, are the predominant microorganisms in community-acquired empyema. However, recent literature suggests that anaerobes and staphylococcal species have replaced Streptococcus pneumoniae as the primary pathogen in surgically treated empyemas. Also, anaerobic isolates were found to have a higher incidence of community-acquired pneumonia than previously reported. Methicillin-resistant Staphylococcus aureus and gram-negative organisms, including Pseudomonas and Enterobacteriaceae, are pathogens commonly seen in hospital-acquired empyema. Anaerobes are slow-growing organisms that notoriously yield negative culture media. Therefore, broad-spectrum antibiotic coverage with anaerobic coverage is warranted.

• #1 Empyema and Abscess Pneumonia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/807499-overview

  The most common cause of an empyema is from a parapneumonic effusion that becomes infected; these account for about half of all empyemas. Other causes of an empyema include the following: Penetrating chest trauma; Undrained hemothoraces, including those secondary to blunt chest trauma; Contamination of a wound during procedures such as needle decompression, chest tube placement, thoracentesis, or thoracic surgery. […] Microbiologic organisms that can cause an empyema include Streptococcus species such as Streptococcus milleri (Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus), S pneumoniae, Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA), and a variety of gram-negative organisms and anaerobes. Anaerobic involvement, either as sole organism or part of a polymicrobial infection, is common in empyemas but may be difficult to detect on cultures. One should always consider enterobacteria, enterococci, and Mycobacterium tuberculosis as potential pathogens. […] Bacteria from the Streptococcus milleri group have become the predominant organism cultured from adults with empyemas, especially in patients with underlying malignancy or diabetes mellitus. Recently, the incidence of staphylococcal-related empyema has increased.

• #1 Empyema

  https://www.nhs.uk/conditions/empyema/

  Empyema is the medical term for pockets of pus that have collected inside a body cavity. […] They can form if a bacterial infection is left untreated, or if it fails to fully respond to treatment. […] The most common cause of empyema is pneumonia caused by a bacterial infection of the lungs. […] An empyema can form when pneumonia fails to fully respond to treatment in a straightforward way. […] Other possible causes are: bronchiectasis a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of mucus that can make the lungs more vulnerable to infection, a blood clot or another blockage this can prevent blood flow to the lungs, causing some of the lung tissue to die (known as a pulmonary infarction), surgery to the chest empyema is a rare complication, an endoscopy empyema is a rare complication, serious injury to the chest, an infection elsewhere in the body that’s spread through the bloodstream, an infection caused by inhaled food if you have swallowing problems this is rare, tuberculosis this is rare in the UK.

• #1 Empyema – UF Health

  https://ufhealth.org/conditions-and-treatments/empyema

  Empyema is usually caused by an infection that spreads directly from the lung. It leads to a buildup of pus in the pleural space. […] Risk factors include: Bacterial pneumonia, Tuberculosis, Chest surgery, Lung abscess, Trauma or injury to the chest. […] In rare cases, empyema can occur after thoracentesis.

• #1

  https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/critical-care-cases/bilateral-empyema-in-an-immunocompromised-patient.php

  Bilateral empyema is basically limited to conditions leading to acute bacterial mediastinitis, such as esophageal rupture, trauma and infections arising in the neck or teeth and gums, with spread of anaerobic bacteria to the mediastinum. […] Community acquired pneumonia, thoracentesis, malignancy and rheumatoid arthritis are well known causes of unilateral empyema but rarely bilateral empyema, especially in immunocompetent patients. […] Infectious causes of mediastinitis include mediastinal extension of pulmonary infections and head and neck infections, most commonly odontogenic infections or retropharyngeal abscesses. […] Other causes include peritonsillar abscesses, cervical lymphadenitis, clavicular osteomyelitis and, rarely, parotitis and thyroiditis. […] The causative organisms vary depending upon the origin of the infection. In the majority of cases it is a mixed aerobic and anaerobic infection. The following bacteria are most commonly identified: Streptococcus viridans species, coagulase negative staphylococci, Staphylococcus aureus, Bacteroides species, Peptostreptococcus species, Prevotella species, Fusobacterium species, Actinomyces species, Klebsiella pneumoniae, Haemophilus influenzae, Gemella morbillorum, Candida albicans, and Aspergillus species.

• #1 Empyema: Causes, Types, and Symptoms

  https://www.healthline.com/health/empyema

  Having pneumonia is a top risk factor for empyema in the lungs. […] Empyema usually develops after pneumonia, which is an infection of the lung tissue. […] Empyema can develop after you have pneumonia. […] Many different types of bacteria may cause pneumonia, but the two most common are Streptococcus pneumoniae and Staphylococcus aureus. […] Occasionally, empyema may happen after you’ve had surgery on your chest. Medical instruments can transfer bacteria into your pleural cavity. […] The pleural space naturally has some fluid, but infection can cause fluid to build up faster than it can be absorbed. The fluid then becomes infected with the bacteria that caused the pneumonia or infection. […] If it’s not treated, empyema can lead to potentially life-threatening complications such as sepsis.

• #1 Empyema Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/empyema

  Empyema is usually caused by an infection that spreads directly from the lung. It leads to a buildup of pus in the pleural space. […] Risk factors include: Bacterial pneumonia, Tuberculosis, Chest surgery, Lung abscess, Trauma or injury to the chest. […] In rare cases, empyema can occur after thoracentesis. This is a procedure in which a needle is inserted through the chest wall to remove fluid in the pleural space for medical diagnosis or treatment.

• #1 Pleural empyema | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pleural-empyema-1?lang=us

  Pleural empyema refers to a collection of pus in the pleural cavity which may contain gas locules. Empyema is usually unilateral and most often occurs as a complication of pneumonia or perforated esophagus. […] Empyemas are usually the complication of another underlying abnormality, and thus demographics will follow those of the primary cause, e.g. pneumonia, subdiaphragmatic abscess, esophageal perforation, etc. […] Patients with HIV/AIDS are more likely to have pneumonia, and in turn are more likely to develop empyema, which may occur in 5% of cases of pneumonia. […] Offending organisms vary somewhat according to the age at which the empyema develops and the underlying cause. For parapneumonic empyemas the most frequent organisms are: childhood – Pneumococcus; adults – penicillin-resistant Staphylococcus aureus, gram-negative bacteria, anaerobic bacteria: usually polymicrobial. […] In the setting of trauma or thoracic surgery, Staphylococcus aureus is usually involved. […] Other uncommon causes include mycobacterial infection, resulting in tuberculous empyema.

• #1 Empyema: What It Is, Treatment, and More

  https://www.webmd.com/lung/what-is-empyema

  Empyema is a condition where you have pus between your lung and the membrane surrounding it. Its caused by an infection and can cause symptoms such as pain and shortness of breath. […] Youre more likely to develop empyema if you have conditions like chest trauma or pneumonia. […] Empyema occurs when pus starts building up in the cavity thats between your lung and the pleural space, which is the membrane surrounding your lung. […] This condition is the result of an infection that spreads to the lung. […] Youre more likely to have empyema if you have or recently had conditions such as lung abscess, chest injury or trauma, or thoracic surgery. […] Other risk factors include intravenous drug abuse, gastric acid reflex, alcohol abuse, diabetes mellitus, and immunosuppression. […] You can get empyema through bacterial or fungal infections.

• #1 Most common Cause of Empyema – Dr Belal Bin Asaf

  https://drbelalbinasaf.com/blog/most-common-cause-of-empyema/

  Tuberculosis (TB) is a bacterial infection that primarily affects the lungs. In some cases, TB can lead to the formation of abscesses in the lungs and spread into the pleural space, causing empyema. […] Chronic conditions such as chronic obstructive pulmonary disease (COPD) or asthma can increase the risk of infections, which can lead to pneumonia and, eventually, empyema. […] Individuals who have recently had bacterial pneumonia, lung abscess, or chest surgery are at a higher risk of developing empyema. Similarly, trauma or injury to the chest can increase the likelihood of this complication. […] Diabetes mellitus, particularly when poorly controlled, can impair the immune system’s response to infections. People with diabetes are at increased risk of infections, including those that can lead to empyema.

• #1 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  The development of empyema as a result of pleural infection occurs in 3 stages: Exudative stage (stage I): a small amount of sterile fluid is accumulated in the pleural space following acute inflammatory response; Fibropurulent stage (stage II): increased neutrophil counts and fibrin deposition due to an infection and collection of pleural fluid in loculated segments; Organized stage (stage III): fibrin deposits and production of a thick pleural peel lead to restricted lung expansion and chronic empyema.

• #1 Spontaneous Bacterial Empyema: Symptoms, Causes, Treatment

  https://www.healthline.com/health/spontaneous-bacterial-empyema

  Spontaneous bacterial empyema is a complication of hepatic hydrothorax, which itself is a complication of cirrhosis. […] Cirrhosis is scarring of your liver caused by long-term damage. The most common cause is drinking too much alcohol for many years. […] Spontaneous bacterial empyema occurs when a bacterial infection develops in the excess fluid around the lungs of a person with hepatic hydrothorax. Some researchers have suggested that spontaneous bacterial empyema might develop due to ruptured blisters between the abdominal and pleural cavities, which may cause bacteria-containing fluid to enter the space around the lungs. […] In a 2022 review, the most common bacteria identified in people with spontaneous bacterial empyema were Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, and Enterococcus.

• #1 Intracranial Epidural Abscess and Subdural Empyema – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/brain-infections/intracranial-epidural-abscess-and-subdural-empyema

  Intracranial epidural abscesses and subdural empyemas may result from a sinus or an ear infection or from conditions that allow bacteria to enter the skull, such as a head injury or head surgery. […] Epidural abscesses and subdural empyemas may result from A sinus infection, A severe ear infection (such as chronic otitis media), A head injury that allows bacteria to enter the skull, Surgery on the head that allows bacteria to enter the skull, Rarely, a blood infection. […] The same kinds of bacteria that cause brain abscesses (such as Staphylococcus aureus and Bacteroides fragilis) can cause epidural abscesses and subdural empyemas. […] In children younger than 5 years, the cause is usually bacterial meningitis. Because meningitis is now uncommon in children, epidural abscesses and subdural empyemas are also uncommon in children.

• #1 Empyema (Pus in) Gallbladder : Causes & Treatment – Dr AvinashTank, is a super-specialist (MCh) Laparoscopic Gastro-intestinal Surgeon,

  https://dravinashtank.in/gastro_health/empyema-pus-in-gallbladder-causes-treatment/

  Empyema of the gallbladder refers to the accumulation of infected pus within the gallbladder. […] This condition typically arises from untreated acute cholecystitis, which is the inflammation of the gallbladder due to gallstones. […] Empyema of the gallbladder primarily occurs due to the following causes: […] The presence of gallstones in the gallbladder can obstruct the cystic duct, leading to inflammation. If left untreated, this inflammation can progress to empyema. […] In some cases, bacterial infection can occur alongside gallstone-related inflammation, resulting in the formation of pus within the gallbladder.

• #1 Pleural empyema – Wikipedia

  https://en.wikipedia.org/wiki/Pleural_empyema

  Risk factors include alcoholism, drug use, HIV infection, neoplasm and pre-existent pulmonary disease. […] In an analysis of 78 children with community acquired pleural empyema, no micro-organism was found in 27% of patients, Streptococcus pneumoniae in 51%, Streptococcus pyogenes in 9% and Staphylococcus aureus in 8%.

• #1 Bacterial Causes of Empyema in Children, Australia, 2007–2009 – Volume 17, Number 10—October 2011 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/17/10/10-1825_article

  An increase in the incidence of empyema worldwide could be related to invasive pneumococcal disease caused by emergent nonvaccine replacement serotypes. […] Many organisms cause empyema in children; Streptococcus pneumoniae is the most common. Other important causes, which are becoming increasingly frequent in several countries, are methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA). […] The reasons for this increase are unknown but may be related to IPD caused by emergent nonvaccine replacement serotypes, particularly serotypes 1, 3, and 19A after the introduction of PCV7. […] By far, the most common organism identified was S. pneumoniae. A variety of organisms other than S. pneumoniae were detected by culture and PCR. […] This study confirmed the findings of others, demonstrating enhanced sensitivity of molecular techniques.

• #1 Pneumonia and empyema: causal, casual or unknown – McCauley – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/4297/html

  Parapneumonic effusions arise from inflammation in the lungs and pleural space from direct invasion of bacteria, cascade of inflammatory events and bacteriologic virulence features. […] Independent risk factors for the development of empyema include diabetes, immunosuppression, gastro-esophageal reflux disease, alcohol and intravenous drug abuse, aspiration, and poor oral hygiene. […] Other causes of empyema include complications after thoracic surgical procedures, trauma, esophageal perforation, thoracentesis and subdiaphragmatic infection. […] The difference in the bacteriology between pneumonia and pleural infections may be related to the acidic and hypoxic environment of the infected pleural space and bacterial virulence factors favoring certain pathogens. […] Furthermore, the difference in bacterial species between pleural infections and pneumonia, along with lack of chest imaging evidence of pneumonia in some patients, have led some experts to question the conventional belief that empyema and pneumonia are inherently related.

• #2 Empyema

  https://www.nhs.uk/conditions/empyema/

  Empyema is the medical term for pockets of pus that have collected inside a body cavity. […] They can form if a bacterial infection is left untreated, or if it fails to fully respond to treatment. […] The most common cause of empyema is pneumonia caused by a bacterial infection of the lungs. […] An empyema can form when pneumonia fails to fully respond to treatment in a straightforward way. […] Other possible causes are: bronchiectasis a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of mucus that can make the lungs more vulnerable to infection, a blood clot or another blockage this can prevent blood flow to the lungs, causing some of the lung tissue to die (known as a pulmonary infarction), surgery to the chest empyema is a rare complication, an endoscopy empyema is a rare complication, serious injury to the chest, an infection elsewhere in the body that’s spread through the bloodstream, an infection caused by inhaled food if you have swallowing problems this is rare, tuberculosis this is rare in the UK.

• #2 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Empyema thoracis, meaning pus in the chest in Greek, occurs when infections from various parts of the body spread to the pleural space. The most common cause of empyema is bacterial pneumonia and its resulting parapneumonic effusion. Approximately 20% to 40% of patients admitted for pneumonia experience associated parapneumonic effusion. Among these, 5% to 10% will develop empyema; 30% of these patients require surgical drainage, and the mortality rate for these patients is 15%. Less frequently, empyema can arise from conditions such as bronchogenic carcinoma, esophageal rupture, blunt or penetrating chest trauma, infectious mediastinitis spreading to the pleurae, infection crossing the diaphragm from abdominal sources, spinal infections, or postsurgical complications. […] The development of pleural space infections likely involves increased permeability of the mesothelial layer of the inflamed pleurae, allowing bacteria to invade the typically sterile space. Interestingly, up to 56% of community-acquired and 73% of hospital-acquired pleural space infections demonstrate no radiographic signs of pneumonia. This, along with differing microbial profiles between pneumonia and pleural infections, suggests that hematogenous spread might be a factor in some patients with empyema. Despite these varied mechanisms, the most common etiologic pathway involves the aspiration of organisms from the oropharynx, leading to pneumonia in the dependent lobes, which, if left untreated, can progress to parapneumonic effusion and, ultimately, empyema.

• #2 Empyema: Causes, Types, and Symptoms

  https://www.healthline.com/health/empyema

  Having pneumonia is a top risk factor for empyema in the lungs. […] Empyema usually develops after pneumonia, which is an infection of the lung tissue. […] Empyema can develop after you have pneumonia. […] Many different types of bacteria may cause pneumonia, but the two most common are Streptococcus pneumoniae and Staphylococcus aureus. […] Occasionally, empyema may happen after you’ve had surgery on your chest. Medical instruments can transfer bacteria into your pleural cavity. […] The pleural space naturally has some fluid, but infection can cause fluid to build up faster than it can be absorbed. The fluid then becomes infected with the bacteria that caused the pneumonia or infection. […] If it’s not treated, empyema can lead to potentially life-threatening complications such as sepsis.

• #2 Understanding Empyema: Causes, Diagnosis, and Treatment – Dr Ricardo Jose – London Chest Specialist

  https://londonchestspecialist.co.uk/2023/07/21/understanding-empyema-diagnosis-and-treatment/

  Empyema is most often caused by a bacterial infection, often as a result of pneumonia or following a surgical procedure on the chest. Bacteria causing pneumonia can spread to the pleural space, causing a build-up of pus and fluid. […] Common pathogens seen in empyema include Streptococcus mitis, Streptococcus pneumoniae, Staphylococcus aureus, and a variety of anaerobic bacteria. Other conditions such as a lung abscess or severe case of tuberculosis can also lead to empyema.

• #2 Empyema: What It Is, Treatment, and More

  https://www.webmd.com/lung/what-is-empyema

  You can get empyema by being exposed to various types of bacteria, such as Streptococcus aureus and Pseudomonas. […] The bacteria cause inflammation, which causes more fluid to be produced in the pleural cavity. […] Fungal empyema is rare and associated with higher mortality. The most common type of fungus associated with this kind of infection is the Candida species.

• #2 Empyema and Lung Infection – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/lung-center/diseases-and-conditions/empyema-and-lung-infection

  Empyema develops when bacteria invades the pleural space. […] Empyema is typically caused by an infection such as pneumonia or following surgery. […] Chronic infections of the lungs from pneumonia, tuberculosis, non-tuberculous mycobacterial (NTM) infections and influenza as well as fungal and bacterial infections can also be extremely serious, leading to millions of deaths worldwide annually.

• #2 Most common Cause of Empyema – Dr Belal Bin Asaf

  https://drbelalbinasaf.com/blog/most-common-cause-of-empyema/

  While bacterial pneumonia is the most common cause of empyema, there are several other conditions that can lead to this serious complication. These include complications from lung surgery, ruptured lung abscesses, chest injuries or trauma, and infections from IV drug use. […] A lung abscess is a localized collection of pus within the lung tissue. If an abscess ruptures, it can spread the infection into the pleural space, resulting in empyema. […] Any physical injury to the chest, such as a broken rib or a penetrating wound, can lead to an infection in the pleural space. If the injury leads to a bacterial infection, the accumulation of pus (empyema) can occur. […] Intravenous (IV) drug use, especially with unclean needles or in unsanitary conditions, can lead to infections in the bloodstream. These infections can spread to the lungs or pleural space, potentially causing empyema.

• #2 Empyema | nidirect

  https://www.nidirect.gov.uk/conditions/empyema

  Empyema can worsen to become many more pockets of pus, with thick deposits coating the outer layer of the lungs. These deposits prevent the lungs expanding properly. […] The most common cause of empyema is pneumonia caused by a bacterial infection of the lungs. An empyema can form when a person with pneumonia fails to fully get better with treatment. […] Other possible causes are: bronchiectasis, a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of mucus that can make the lungs more vulnerable to infection; a blood clot or other blockage preventing blood flow to the lungs, causing some of the lung tissue to die – this is known as a pulmonary infarction; surgery to the chest (empyema is a rare complication); an endoscopy (empyema is a rare complication); a serious injury to the chest; an infection elsewhere in the body that has spread via the bloodstream; an infection caused by inhaled food, if you have swallowing problems (but this is rare); tuberculosis (this is rare in Northern Ireland).

• #2 Parapneumonic Pleural Effusions and Empyema Thoracis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/298485-overview

  Pneumonia is the leading cause of parapneumonic effusions and empyema thoracis. Increasingly, empyema is also a complication of previous cardiothoracic surgery, which accounts for 30% of cases. The usual organisms are Staphylococcus species and gram-negative bacteria. Trauma can also lead to inoculation and superinfection of the pleural space. […] In the absence of trauma or surgery, the infecting organism may have spread from blood or other organs into the pleural space. Possible causes include extension of infections from adjacent or distant sites (eg, ruptured esophagus, mediastinitis, osteomyelitis, pericarditis, cholangitis, diverticulitis, or pericarditis) and subdiaphragmatic abscesses.

• #2 Empyema and Abscess Pneumonia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/807499-overview

  The most common cause of an empyema is from a parapneumonic effusion that becomes infected; these account for about half of all empyemas. Other causes of an empyema include the following: Penetrating chest trauma; Undrained hemothoraces, including those secondary to blunt chest trauma; Contamination of a wound during procedures such as needle decompression, chest tube placement, thoracentesis, or thoracic surgery. […] Microbiologic organisms that can cause an empyema include Streptococcus species such as Streptococcus milleri (Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus), S pneumoniae, Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA), and a variety of gram-negative organisms and anaerobes. Anaerobic involvement, either as sole organism or part of a polymicrobial infection, is common in empyemas but may be difficult to detect on cultures. One should always consider enterobacteria, enterococci, and Mycobacterium tuberculosis as potential pathogens. […] Bacteria from the Streptococcus milleri group have become the predominant organism cultured from adults with empyemas, especially in patients with underlying malignancy or diabetes mellitus. Recently, the incidence of staphylococcal-related empyema has increased.

• #2 Pleural Empyema – What You Need to Know

  https://www.drugs.com/cg/pleural-empyema.html

  Pleural empyema is usually caused by pneumonia. The following are also causes: […] A bacterial infection, such as pneumonia or tuberculosis (TB) […] Surgery on your chest […] A lung abscess […] A lung disease, such as COPD or lung cancer […] A chest injury […] Thoracentesis (procedure to remove a fluid sample through a needle).

• #2 Empyema (collection of pus) – CIRSE

  https://www.cirse.org/patients/general-information/medical-conditions/empyema-collection-of-pus/

  When this develops in the pleural cavity (the space between the two thin membranes surrounding your lungs,) it is called pleural empyema. This is usually caused by an infection that spreads from the lung to the pleural cavity, but can be caused by anything that introduces infectious agents to the area, including chest trauma or surgery and tears to the gullet. […] Gallbladder empyema commonly results from advanced gallbladder inflammation, with gallstones blocking the passage of bile. Gallbladder empyema can also result from blockage by other causes, such as cancer of the pancreatic head.

• #2 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Many pleural space infections present as complications from community- or hospital-acquired pneumonia. Other causes include penetrating chest trauma, thoracic surgery, esophageal rupture, pulmonary tuberculosis, lung abscess, bronchiectasis, subphrenic abscess, and osteomyelitis of ribs. Independent risk factors for empyema development include: Younger than 60, Poor oral hygiene, Disorders with a predisposition to aspiration (seizure, alcohol use disorder, central nervous system disease), Intravenous drug misuse, Diabetes, Cardiovascular disease, Liver cirrhosis, Other immunocompromised states (eg, human immunodeficiency virus infection or malignancy). […] Aerobic Staphylococcus and Streptococcus species and gram-negative bacteria, including Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae, are the predominant microorganisms in community-acquired empyema. However, recent literature suggests that anaerobes and staphylococcal species have replaced Streptococcus pneumoniae as the primary pathogen in surgically treated empyemas. Also, anaerobic isolates were found to have a higher incidence of community-acquired pneumonia than previously reported. Methicillin-resistant Staphylococcus aureus and gram-negative organisms, including Pseudomonas and Enterobacteriaceae, are pathogens commonly seen in hospital-acquired empyema. Anaerobes are slow-growing organisms that notoriously yield negative culture media. Therefore, broad-spectrum antibiotic coverage with anaerobic coverage is warranted.

• #2 Pneumonia and empyema: causal, casual or unknown – McCauley – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/4297/html

  Parapneumonic effusions arise from inflammation in the lungs and pleural space from direct invasion of bacteria, cascade of inflammatory events and bacteriologic virulence features. […] Independent risk factors for the development of empyema include diabetes, immunosuppression, gastro-esophageal reflux disease, alcohol and intravenous drug abuse, aspiration, and poor oral hygiene. […] Other causes of empyema include complications after thoracic surgical procedures, trauma, esophageal perforation, thoracentesis and subdiaphragmatic infection. […] The difference in the bacteriology between pneumonia and pleural infections may be related to the acidic and hypoxic environment of the infected pleural space and bacterial virulence factors favoring certain pathogens. […] Furthermore, the difference in bacterial species between pleural infections and pneumonia, along with lack of chest imaging evidence of pneumonia in some patients, have led some experts to question the conventional belief that empyema and pneumonia are inherently related.

• #2 Pediatric empyema – Children’s Health Pulmonology

  https://www.childrens.com/specialties-services/conditions/pediatric-empyema

  Empyema (empyema) in children is a condition that causes pus to pool in the area between the lungs and the chest wall. […] When a child has empyema, pus (fluid filled with immune cells, bacteria and dead cells) pools in the area between the lungs and the inner surface of the chest wall known as the pleural space. […] In most cases, empyema develops after a child has had pneumonia. […] Your child is at an increased risk to develop post-pneumonia empyema if they also have: Abscess of the lung, Bronchiectasis, Chronic obstructive pulmonary disorder (COPD), Compromised immune system, Diabetes, Recent traumatic injury, Rheumatoid arthritis, Surgery.

• #2 What Is Gallbladder Empyema?

  https://www.icliniq.com/articles/gastro-health/gallbladder-empyema

  Empyema of the gallbladder occurs when acute cholecystitis in the presence of bacteria-containing bile leads to suppurative infection in which the gallbladder is filled with purulent material. […] The cause of acute cholecystitis involves obstruction of the cystic duct leading to the buildup of infected fluid. […] The empyema of the gallbladder is seen in association with acute calculus cholecystitis, where there is stasis of bile and an obstructed cystic duct. […] The organisms that are most frequently isolated are Clostridia species, Klebsiella pneumoniae, Bacteroides, Streptococcus faecalis, and Escherichia coli. […] The stagnant bile in the gallbladder is contaminated with microorganisms leading to pus formation in an actively inflamed gallbladder, and thus the gallbladder lumen is filled with pus and exudative material.

• #2 Bacterial Causes of Empyema in Children, Australia, 2007–2009 – Volume 17, Number 10—October 2011 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/17/10/10-1825_article

  An increase in the incidence of empyema worldwide could be related to invasive pneumococcal disease caused by emergent nonvaccine replacement serotypes. […] Many organisms cause empyema in children; Streptococcus pneumoniae is the most common. Other important causes, which are becoming increasingly frequent in several countries, are methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA). […] The reasons for this increase are unknown but may be related to IPD caused by emergent nonvaccine replacement serotypes, particularly serotypes 1, 3, and 19A after the introduction of PCV7. […] By far, the most common organism identified was S. pneumoniae. A variety of organisms other than S. pneumoniae were detected by culture and PCR. […] This study confirmed the findings of others, demonstrating enhanced sensitivity of molecular techniques.

• #2 Bacterial Causes of Empyema in Children, Australia, 2007–2009 – Volume 17, Number 10—October 2011 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/17/10/10-1825_article

  Overall, this study suggests the efficacy of the PCV7, as previously confirmed. However, public health authorities should be concerned that most pneumococcal infections were caused by nonvaccine serotypes, possibly related to replacement disease after the introduction of PCV7 onto the national vaccination schedule in 2005. […] Most infections were caused by nonPCV7 pneumococcal serotypes, which suggests that coverage of pneumococcal serotypes by vaccines needs to be broadened.

• #2 Pneumonia and empyema: causal, casual or unknown – McCauley – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/4297/html

  Patient factors and comorbidities also contribute to the pathophysiology of parapneumonic effusion development. […] This may be related to something inherent about the parapneumonic effusion and/or a more robust inflammatory response. […] Underlying comorbidities or patient factors may not only contribute to the development of a parapneumonic effusion, but might be the cause of increased mortality.

• #3 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Empyema thoracis, meaning pus in the chest in Greek, occurs when infections from various parts of the body spread to the pleural space. The most common cause of empyema is bacterial pneumonia and its resulting parapneumonic effusion. Approximately 20% to 40% of patients admitted for pneumonia experience associated parapneumonic effusion. Among these, 5% to 10% will develop empyema; 30% of these patients require surgical drainage, and the mortality rate for these patients is 15%. Less frequently, empyema can arise from conditions such as bronchogenic carcinoma, esophageal rupture, blunt or penetrating chest trauma, infectious mediastinitis spreading to the pleurae, infection crossing the diaphragm from abdominal sources, spinal infections, or postsurgical complications. […] The development of pleural space infections likely involves increased permeability of the mesothelial layer of the inflamed pleurae, allowing bacteria to invade the typically sterile space. Interestingly, up to 56% of community-acquired and 73% of hospital-acquired pleural space infections demonstrate no radiographic signs of pneumonia. This, along with differing microbial profiles between pneumonia and pleural infections, suggests that hematogenous spread might be a factor in some patients with empyema. Despite these varied mechanisms, the most common etiologic pathway involves the aspiration of organisms from the oropharynx, leading to pneumonia in the dependent lobes, which, if left untreated, can progress to parapneumonic effusion and, ultimately, empyema.

• #3 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Many pleural space infections present as complications from community- or hospital-acquired pneumonia. Other causes include penetrating chest trauma, thoracic surgery, esophageal rupture, pulmonary tuberculosis, lung abscess, bronchiectasis, subphrenic abscess, and osteomyelitis of ribs. Independent risk factors for empyema development include: Younger than 60, Poor oral hygiene, Disorders with a predisposition to aspiration (seizure, alcohol use disorder, central nervous system disease), Intravenous drug misuse, Diabetes, Cardiovascular disease, Liver cirrhosis, Other immunocompromised states (eg, human immunodeficiency virus infection or malignancy). […] Aerobic Staphylococcus and Streptococcus species and gram-negative bacteria, including Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae, are the predominant microorganisms in community-acquired empyema. However, recent literature suggests that anaerobes and staphylococcal species have replaced Streptococcus pneumoniae as the primary pathogen in surgically treated empyemas. Also, anaerobic isolates were found to have a higher incidence of community-acquired pneumonia than previously reported. Methicillin-resistant Staphylococcus aureus and gram-negative organisms, including Pseudomonas and Enterobacteriaceae, are pathogens commonly seen in hospital-acquired empyema. Anaerobes are slow-growing organisms that notoriously yield negative culture media. Therefore, broad-spectrum antibiotic coverage with anaerobic coverage is warranted.

• #3 Pneumonia and empyema: causal, casual or unknown – McCauley – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/4297/html

  Parapneumonic effusions arise from inflammation in the lungs and pleural space from direct invasion of bacteria, cascade of inflammatory events and bacteriologic virulence features. […] Independent risk factors for the development of empyema include diabetes, immunosuppression, gastro-esophageal reflux disease, alcohol and intravenous drug abuse, aspiration, and poor oral hygiene. […] Other causes of empyema include complications after thoracic surgical procedures, trauma, esophageal perforation, thoracentesis and subdiaphragmatic infection. […] The difference in the bacteriology between pneumonia and pleural infections may be related to the acidic and hypoxic environment of the infected pleural space and bacterial virulence factors favoring certain pathogens. […] Furthermore, the difference in bacterial species between pleural infections and pneumonia, along with lack of chest imaging evidence of pneumonia in some patients, have led some experts to question the conventional belief that empyema and pneumonia are inherently related.

• #4 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Many pleural space infections present as complications from community- or hospital-acquired pneumonia. Other causes include penetrating chest trauma, thoracic surgery, esophageal rupture, pulmonary tuberculosis, lung abscess, bronchiectasis, subphrenic abscess, and osteomyelitis of ribs. Independent risk factors for empyema development include: Younger than 60, Poor oral hygiene, Disorders with a predisposition to aspiration (seizure, alcohol use disorder, central nervous system disease), Intravenous drug misuse, Diabetes, Cardiovascular disease, Liver cirrhosis, Other immunocompromised states (eg, human immunodeficiency virus infection or malignancy). […] Aerobic Staphylococcus and Streptococcus species and gram-negative bacteria, including Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae, are the predominant microorganisms in community-acquired empyema. However, recent literature suggests that anaerobes and staphylococcal species have replaced Streptococcus pneumoniae as the primary pathogen in surgically treated empyemas. Also, anaerobic isolates were found to have a higher incidence of community-acquired pneumonia than previously reported. Methicillin-resistant Staphylococcus aureus and gram-negative organisms, including Pseudomonas and Enterobacteriaceae, are pathogens commonly seen in hospital-acquired empyema. Anaerobes are slow-growing organisms that notoriously yield negative culture media. Therefore, broad-spectrum antibiotic coverage with anaerobic coverage is warranted.

• #4 Empyema and Abscess Pneumonia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/807499-overview

  Empyema is defined as pus in the pleural space. It typically is a complication of pneumonia. However, it can also arise from penetrating chest trauma, esophageal rupture, complication from lung surgery, or inoculation of the pleural cavity after thoracentesis or chest tube placement. An empyema can also occur from extension of a subdiaphragmatic or paravertebral abscess. […] The most common cause of lung abscess is aspiration. Risk factors include the following: Poor dentition, periodontal infection; Seizure disorder; Alcohol and drug abuse; Electronic cigarette use; Diabetes mellitus; COVID-19; Gastroesophageal reflux disease; Inability to protect the airway because of an absent gag reflex (eg, patients who are comatose, have a change in mentation or bulbar dysfunction, or who might be undergoing general anesthesia); Primary lung disorders, such as septic emboli, pulmonary vasculitis, cavitating lung malignancy, or pulmonary cystic disease; Penetrating chest trauma; Immunosuppression; Conditions associated with septic emboli, including intravenous drug use, soft tissue infections, valvular heart disease, and individuals with intravascular prosthetic material.

• #5 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  Defined as a collection of pus in the thoracic cavity arising from infection in the pleural space, empyema is most commonly caused by bacterial pneumonia and the resulting accumulation of fluid (parapneumonic effusion) in the pleural space. Approximately 20% to 40% of patients who are hospitalized for pneumonia in the United States (US) develop a parapneumonic effusion, and approximately 5% to 10% of them develop empyema. In addition to parapneumonic effusion, other causes of empyema include thoracic surgery, chest trauma, lung abscess, cervical or thoracic spine infections, bronchogenic carcinoma, and esophageal rupture. Patients are at an increased risk for empyema if they are of advanced age or have one of the following conditions: diabetes, immunosuppression, cardiovascular disease, liver cirrhosis, gastric acid reflux, and alcohol and intravenous drug abuse. Studies have shown that community-acquired pleural infections most commonly arise from aerobic Streptococcus (Streptococcus pneumoniae, S intermedius, and other streptococcal species), Staphylococcus, and gram-negative bacteria (Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae); however, hospital-acquired infections most frequently arise from methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria (pseudomonas and enterobacteriaceae).

• #5 Empyema: What It Is, Treatment, and More

  https://www.webmd.com/lung/what-is-empyema

  Empyema is a condition where you have pus between your lung and the membrane surrounding it. Its caused by an infection and can cause symptoms such as pain and shortness of breath. […] Youre more likely to develop empyema if you have conditions like chest trauma or pneumonia. […] Empyema occurs when pus starts building up in the cavity thats between your lung and the pleural space, which is the membrane surrounding your lung. […] This condition is the result of an infection that spreads to the lung. […] Youre more likely to have empyema if you have or recently had conditions such as lung abscess, chest injury or trauma, or thoracic surgery. […] Other risk factors include intravenous drug abuse, gastric acid reflex, alcohol abuse, diabetes mellitus, and immunosuppression. […] You can get empyema through bacterial or fungal infections.

• #5 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Many pleural space infections present as complications from community- or hospital-acquired pneumonia. Other causes include penetrating chest trauma, thoracic surgery, esophageal rupture, pulmonary tuberculosis, lung abscess, bronchiectasis, subphrenic abscess, and osteomyelitis of ribs. Independent risk factors for empyema development include: Younger than 60, Poor oral hygiene, Disorders with a predisposition to aspiration (seizure, alcohol use disorder, central nervous system disease), Intravenous drug misuse, Diabetes, Cardiovascular disease, Liver cirrhosis, Other immunocompromised states (eg, human immunodeficiency virus infection or malignancy). […] Aerobic Staphylococcus and Streptococcus species and gram-negative bacteria, including Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae, are the predominant microorganisms in community-acquired empyema. However, recent literature suggests that anaerobes and staphylococcal species have replaced Streptococcus pneumoniae as the primary pathogen in surgically treated empyemas. Also, anaerobic isolates were found to have a higher incidence of community-acquired pneumonia than previously reported. Methicillin-resistant Staphylococcus aureus and gram-negative organisms, including Pseudomonas and Enterobacteriaceae, are pathogens commonly seen in hospital-acquired empyema. Anaerobes are slow-growing organisms that notoriously yield negative culture media. Therefore, broad-spectrum antibiotic coverage with anaerobic coverage is warranted.

• #6 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  Defined as a collection of pus in the thoracic cavity arising from infection in the pleural space, empyema is most commonly caused by bacterial pneumonia and the resulting accumulation of fluid (parapneumonic effusion) in the pleural space. Approximately 20% to 40% of patients who are hospitalized for pneumonia in the United States (US) develop a parapneumonic effusion, and approximately 5% to 10% of them develop empyema. In addition to parapneumonic effusion, other causes of empyema include thoracic surgery, chest trauma, lung abscess, cervical or thoracic spine infections, bronchogenic carcinoma, and esophageal rupture. Patients are at an increased risk for empyema if they are of advanced age or have one of the following conditions: diabetes, immunosuppression, cardiovascular disease, liver cirrhosis, gastric acid reflux, and alcohol and intravenous drug abuse. Studies have shown that community-acquired pleural infections most commonly arise from aerobic Streptococcus (Streptococcus pneumoniae, S intermedius, and other streptococcal species), Staphylococcus, and gram-negative bacteria (Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae); however, hospital-acquired infections most frequently arise from methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria (pseudomonas and enterobacteriaceae).

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