Microbiology and management of pleural empyema.

Empyema is apparently becoming more common, with pneumococcus being the most common pathogen detected in Europe and the USA. However, group A streptococcus and S. aureus pneumonia are individually more likely to progress to empyema. Serotype 1 pneumococcus is frequently implicated and the reasons for an apparent increase in incidence remain unclear. Management requires antibiotics and removal of pus either by fibrinolysis or primary drainage.