Factors Affecting the Outcome of Empyema Following Intercostal Tube Drainage and Antibiotic Therapy

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Background: Empyema thoracis is defined as the accumulation of pus within the pleural space. Timely diagnosis and appropriate treatment are critical in determining patient prognosis. This study identifies clinical, radiological, and microbiological factors that affect treatment outcomes (success vs. failure) in patients presenting to the emergency department with suspected empyema thoracis. Early identification and rectification of these factors are essential to improving cure rates and overall clinical outcomes. Methods: This 18-month cross-sectional study was conducted at the Department of Pulmonary Medicine, Government Medical College, Kozhikode, involving 75 patients diagnosed with empyema thoracis. All subjects were treated with empirical antibiotic therapy and intercostal tube drainage (ICD). In cases where loculations were present, intrapleural streptokinase instillation was administered. The protocol for ICD removal required symptomatic improvement and a follow-up ultrasonography (USG) showing reduced fluid (<50 mL). Conversely, if a patient showed no symptomatic improvement, incomplete drainage, and persistent multiloculations on repeat USG, fibrinolytic therapy was considered. Patients failing to respond to medical management (ICD, antibiotics, and fibrinolytics) were referred for surgical treatment. Data were analyzed using MS Excel and suitable statistical software. Selected variables were tested using the Chi-square test, with associations expressed as odds ratios and confidence intervals. Results: Among the 75 patients studied, several variables showed a statistically significant association with poor outcomes ( P < 0.05): (1) prolonged duration of illness ( P = 0.004); (2) Underlying chronic lung diseases, specifically chronic obstructive pulmonary disease, interstitial lung disease, and lung cancer ( P = 0.004); (3) presence of Mycobacterium tuberculosis in pleural fluid ( P = 0.003); and (4) multiloculations identified on USG ( P = 0.004). Conclusion: A delayed interval between the onset of symptoms and the initiation of definitive treatment (antibiotics and ICD), the presence of multiloculated empyema, tuberculous empyema, and underlying chronic lung diseases are significantly associated with poor outcomes. Intrapleural streptokinase instillation remains an effective intervention to improve outcomes in cases of multiloculated empyema.