Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential but should be guided by local microbial guidelines and antimicrobial resistance patterns due to significant geographical variation. Thoracic ultrasound has emerged as a leading imaging technique in parapneumonic effusion, enabling physicians to characterize effusions, assess the underlying parenchyma, and safely guide pleural procedures. Drainage decisions remain based on longstanding criteria including the size of the effusion and fluid gram stain and biochemistry results. Small-bore chest drains appear to be as effective as large bore and are adequate for the delivery of intrapleural enzyme therapy (IET), which is now supported by a large body of evidence. The IET dosing regimen used in the UK Multicenter Sepsis Trial -2 has the most evidence available but data surrounding alternative dosing, concurrent and once-daily instillations, and novel fibrinolytic agents are promising. Prognostic scores used in pneumonia (e.g., CURB-65) tend to underestimate mortality in parapneumonic effusion/empyema. Scores specifically based on pleural infection have been developed but require validation in prospective cohorts.

肺炎旁胸腔积液和脓胸的发病率在全球范围内不断上升，特别是与人口老龄化中的合并症相关。肺炎球菌疫苗的广泛使用也推动了这一变化，导致非疫苗型肺炎球菌和其他细菌的出现。早期全身性抗生素治疗至关重要，但由于显着的地理差异，应遵循当地微生物指南和抗菌药物耐药模式的指导。胸部超声已成为肺炎旁胸腔积液的领先成像技术，使医生能够表征胸腔积液、评估底层实质并安全指导胸膜手术。引流决定仍然基于长期存在的标准，包括积液的大小、液体革兰氏染色和生物化学结果。小口径胸腔引流管似乎与大口径胸腔引流管一样有效，并且足以进行胸膜内酶疗法（IET），这一点现已得到大量证据的支持。英国多中心脓毒症试验 -2 中使用的 IET 给药方案拥有最多的可用证据，但有关替代给药、同时和每日一次滴注以及新型纤溶药物的数据是有希望的。肺炎中使用的预后评分（例如 CURB-65）往往会低估肺炎旁胸腔积液/脓胸的死亡率。专门基于胸膜感染的评分已经制定，但需要在前瞻性队列中进行验证。英国多中心脓毒症试验 -2 中使用的 IET 给药方案拥有最多的可用证据，但有关替代给药、同时和每日一次滴注以及新型纤溶药物的数据是有希望的。肺炎中使用的预后评分（例如 CURB-65）往往会低估肺炎旁胸腔积液/脓胸的死亡率。专门基于胸膜感染的评分已经制定，但需要在前瞻性队列中进行验证。英国多中心脓毒症试验 -2 中使用的 IET 给药方案拥有最多的可用证据，但有关替代给药、同时和每日一次滴注以及新型纤溶药物的数据是有希望的。肺炎中使用的预后评分（例如 CURB-65）往往会低估肺炎旁胸腔积液/脓胸的死亡率。专门基于胸膜感染的评分已经制定，但需要在前瞻性队列中进行验证。