Antibiotic management of empyema complicating thoracic trauma or haemothorax
Patients presenting immediately after thoracic trauma or haemothorax (pleural bleeding) who do not have an active infection (empyema) may require antibiotic prophylaxis around the time of intercostal catheter insertion, if done emergently – see Prophylaxis for traumatic wounds.
Patients with empyema complicating thoracic trauma or haemothorax require:
- admission to hospital
- pleural fluid sampling and drainage
- intravenous antibiotics.
For the definitions of empyema complicating thoracic trauma or haemothorax, and a summary of management, see Definitions and management of parapneumonic effusion and thoracic empyema.
In patients with empyema complicating thoracic trauma or haemothorax, likely pathogens include Staphylococcus aureus, streptococci and anaerobesMandal, 1997.
Collect pleural fluid samples for culture and biochemical analysis. Culturing pleural fluid in blood culture bottles, in addition to standard culture, can increase microbial yieldMenzies, 2011.
If available, use the results of microbiological investigations to guide antibiotic therapy, noting that these infections are typically polymicrobial.
If microbiological results are not available or are negative, empirical antibiotic choice depends on whether the patient has sepsis or septic shock. Antibiotic choice is further affected by the patient’s risk of infection with methicillin-resistant S. aureus (MRSA). Treatment regimens for empyema complicating thoracic trauma or haemothorax are included for: