Seventy-five adult and 25 pediatric patients with empyema thoracis are reported upon herein. A high incidence of postpneumonectomy and postlobectomy empyema were found in the adult population, 15.5 and 3.7 per cent, respectively. The causal factors of such a high incidence are unknown. Faulty surgical techniques and poor clinical judgment in the management of patients undergoing thoracic operations will invariably lead to a significant mortality and morbidity. Morbidity was indirectly evaluated by the length of hospitalization, the mean being 56.8 days for the adult population and 22.6 days for the pediatric group. These figures barely expose the degree of frustration and suffering that patients with empyema thoracis go through. To decrease the incidence of iatrogenic empyema with its associated mortality and morbidity, good clinical judgment and impeccable surgical techniques must be used in the management of patients having thoracic operations. An aggressive approach to drain the empyemic space to allow pulmonary expansion of sterilization of the postpneumonectomy space must be taken once faced with this complication. Children require no more than repeat thoracentesis or placement of an intercostal chest tube to obtain sufficient drainage and recovery. Antibiotic therapy must be selected according to the bacteria encountered and the results of the sensitivity test. Close supervision is mandatory to detect overgrowth, frequently encountered with the use of broad spectrum antibiotics. Anaerobic bacteria as well as fungus and acid-fast bacilli must be searched for during the routine bacteriologic workout.
