Empyema and Parapneumonic Effusions

Paul G. Auwaerter, M.D.

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PATHOGENS

S. pneumoniae and other streptococci (50%)
- Streptococcus intermedius complex ([previously S. milleri], S. anginosus, S. constellatus) now dominates in community-acquired cases.
S. aureus including MRSA (10%)
Anaerobes (20%)
Gram-negative bacilli (GNB, 10%)
Noscomial: Gram-negative bacilli and S. aureus (MRSA)
Rare causes:
- Mycobacterium tuberculosis
- Enterococcus
- Actinomyces
- Other: viruses are a highly unusual cause except for influenza complicated by bacterial superinfection
  - Fungi: rare except immunocompromised hosts
    - Aspergillus
    - Cryptococcus
  - Parasites:
    - Echinococcus
    - Entamoeba histolytica
    - Paragonimus westermani

Major causes in CAP: S. pneumoniae, streptococcal species, S. aureus and anaerobic bacteria (polymicrobial).
- Fulminant course in healthy host: usually MRSA, especially if following influenza as a bacterial superinfection.

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PATHOGENS

S. pneumoniae and other streptococci (50%)
- Streptococcus intermedius complex ([previously S. milleri], S. anginosus, S. constellatus) now dominates in community-acquired cases.
S. aureus including MRSA (10%)
Anaerobes (20%)
Gram-negative bacilli (GNB, 10%)
Noscomial: Gram-negative bacilli and S. aureus (MRSA)
Rare causes:
- Mycobacterium tuberculosis
- Enterococcus
- Actinomyces
- Other: viruses are a highly unusual cause except for influenza complicated by bacterial superinfection
  - Fungi: rare except immunocompromised hosts
    - Aspergillus
    - Cryptococcus
  - Parasites:
    - Echinococcus
    - Entamoeba histolytica
    - Paragonimus westermani

Major causes in CAP: S. pneumoniae, streptococcal species, S. aureus and anaerobic bacteria (polymicrobial).
- Fulminant course in healthy host: usually MRSA, especially if following influenza as a bacterial superinfection.

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