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Hospital-acquired pneumonia — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsHospital-acquired pneumoniaSCE Acute Medicine

A 74-year-old man develops hospital-acquired pneumonia after a stroke. Despite source-directed intravenous antibiotics he remains febrile and needs 40% oxygen after 72 hours. Ultrasound shows a loculated pleural collection; pleural aspiration yields turbid fluid with pH 7.08 and glucose 1.8 mmol/L. What is the most appropriate next intervention?

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Correct answer: C — Insert an image-guided intercostal drain with respiratory oversight

A turbid, loculated parapneumonic effusion with pleural pH below 7.20 is a complicated parapneumonic effusion or empyema and requires drainage as well as antibiotics. Image-guided small-bore drainage is normally appropriate. Failure of drainage should prompt specialist consideration of intrapleural tissue plasminogen activator plus DNase or surgery; antibiotics alone are unlikely to achieve source control.

Reference: https://www.brit-thoracic.org.uk/document-library/guidelines/pleural-disease/online-appendix-c2-pleural-disease-pleural-infection-pleural-fluid-or-radiology-parameters/