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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 414-418, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AK Mandal and H Thadepalli
The need for decortication to cure primary bacterial (nontuberculous)
empyema was evaluated in 112 consecutive patients. Twenty-eight patients
(25%) were cured by thoracentesis alone. Intercostal chest tube drainage
was required in 43 (39%) and decortication in 41 (36%). Although hospital
stay was shortened by 5 days for those who had decortication, the
difference was statistically insignificant. Penicillin failed to eradicate
infection in nine of 17 patients, four of whom had Bacteroides organisms.
There were no therapeutic failures among 46 patients treated with
clindamycin and gentamicin. We conclude that conservative therapy, such as
thoracentesis, antibiotics directed against anaerobic bacteria, and
intercostal tube drainage (thoracostomy), was adequate to achieve clinical
and physiologic resolution in about two thirds of all patients with primary
bacterial empyema. The remaining one third required decortication. Rib
resection and Eloesser flap procedures seem to be unnecessary in the
treatment of primary bacterial empyema.
ARTICLES
Treatment of spontaneous bacterial empyema thoracis
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