Empyemas most often are a consequence of delayed antibiotic therapy
for lung infections. The most important preventive measure, therefore,
is prompt evaluation and initiation of appropriate antibiotics for
patients who present with acute signs and symptoms of pneumonia.
Some patients with empyema due to anaerobic bacteria, however, may
follow an indolent course with early symptoms of chest infection
misdiagnosed as a “chest cold” or “bronchitis.” These
patients may later present with an established empyema that requires
surgical drainage. Most of these patients, however, have risk factors
for aspiration (altered mentation, alcoholism, or poor dentition).
Recognition of these risk factors allows clinicians to identify
patients who would benefit from a chest radiograph at the onset
of new respiratory symptoms, even when the respiratory symptoms
are otherwise mild and nonspecific.