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Empyema — SCE Infectious Diseases MCQ

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EasyRespiratory InfectionEmpyemaSCE Infectious Diseases

A 70-year-old man develops a large right pleural effusion 3 weeks after lower lobe pneumonia. Pleural fluid pH is 6.9, glucose 1.2 mmol/L, LDH 2,500 U/L, and Gram stain shows Gram-positive cocci. What is the most important management step?

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Correct answer: C — Intercostal chest drain insertion plus IV antibiotics

Pleural fluid pH <7.2, glucose <2.2 mmol/L, LDH >1000 U/L, and positive Gram stain define a complicated parapneumonic effusion/empyema requiring drainage. BTS pleural guidelines recommend intercostal chest drain insertion as an urgent priority alongside IV antibiotics (Co-amoxiclav or Ceftriaxone plus Metronidazole to cover oropharyngeal flora and anaerobes). Delay in drainage increases morbidity and may necessitate surgical decortication. Intrapleural fibrinolytics (Alteplase/DNase) can be considered for loculated collections.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections