Pleural Infection in Adults: Integrating Medical and Surgical Management for Optimal Outcomes.
Bhatnagar M., Monsch G-M., Kette S., Schneiter D., Rahman NM., Opitz I., Bedawi EO.
Pleural infection remains a major cause of morbidity and mortality despite advances in antimicrobial therapy, imaging, and surgical techniques. Management is frequently complicated by delayed diagnosis, heterogeneous disease progression, and uncertainty regarding optimal timing of escalation. This article integrates contemporary medical and surgical perspectives on pleural infection, emphasizing early diagnosis, structured reassessment, and timely multidisciplinary decision-making. We discuss the roles and limitations of antibiotics, chest tube drainage, intrapleural enzyme therapy, and surgery across disease stages, highlighting evidence-based criteria for escalation. An integrated physician-surgeon approach is essential to optimize outcomes and prevent progression to advanced empyema.