Empyema of the Thorax Then and Now

Abstract

Several trends were apparent in a series of 122 patients with empyema thoracis hospitalized at the University of Iowa during selected years in each of the last four decades. Admission rate decreased. The fatality rate in 1967 to 1969 was as high (21%) as it had been in 1937 to 1938, though it dropped markedly in intervening years. Pneumococcus was replaced by staphylococcus and gram-negative bacteria as the most frequent microorganisms. Bronchopleural fistulae became rare, and superinfection of the empyema during therapy more common. The incidence of complications, however, did not change. Gravest prognosis was in patients with hospital-acquired empyemas and in patients with underlying illnesses. Mortality was higher in patients over age 50 and in those having a positive empyema culture or gram-negative bacteria.