Case Report

Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

Table 1

Reported cases of empyema necessitans due to S. aureus.

StudyAge of the patientIsolate/organismRisk factorsInvasive proceduresTreatmentOutcomes and complications

Stallworth et al. [14]8 monthsMRSA (blood and pleural fluid)NoneChest tube placementIV vancomycin for a total of 10 days, followed by oral trimethoprim-sulfamethoxazole to complete a 21-day course of antibioticsDischarged home and on follow-up 3 weeks after discharge, the patient was afebrile and asymptomatic
Moore et al. [15]3 monthsMRSA (intraoperative cultures from the right chest wall)NoneThoracotomy with decortication and tube thoracostomy, as well as wide drainage of the subscapular collectionIV vancomycin for a total of 14 days followed by oral linezolid for 7 daysDischarged home in stable condition. No long-term complications were reported
Mizell et al. [13]59 yearsMRSA (blood, urine, and left chest soft tissue mass)Insulin-dependent DM, cirrhosis, heavy alcohol use, and chronic renal failureWedge resection of the left upper lung lobe with tube thoracostomy drainage of the left pleural spaceIV vancomycin was continued for a total of 25 days, followed by a 10-day outpatient course of oral ciprofloxacin and trimethoprim-sulfamethoxazoleNo long-term complications were reported
Contreras et al. [16]19 monthsMRSA (blood, pleural, and chest wall fluid)NoneLeft thoracoscopic decortication and removal of fibrin-purulent exudatesVancomycin and gentamycin were given for two weeks, followed by vancomycin alone for a total of 36 days, followed by oral clindamycin to complete treatment for osteomyelitisRight distal femur osteomyelitis. Discharged home and at follow-up, the patient exhibited no further signs of infection
Rosebush et al. [17]4 weeksMRSA (right chest mass)Exposure to a maternal breast abscess via breast-feedingPercutaneous drainage of right posterolateral chest abscess with pigtail catheter placement4 weeks of IV clindamycin followed by 4 weeks of oral clindamycinOsseous involvement of the right posterolateral 9th, 10th, and 11th ribs. Discharged home. No long-term complications were reported
Edriss and Berdine [5]60 yearsMRSA in sputum and MSSA of the left hip joint aspirateRemote history of alcohol abuse and left total hip arthroplastyWedge resection of the left upper lobe and treatment with IV vancomycin. For MSSA hip septic arthritis, the patient underwent total hip arthroplasty with hardware removal and antibiotic spacer implantationStarted on IV vancomycin and meropenem and discharged on 6–8 weeks of IV antibioticsDischarged home in stable condition. No long-term complications were reported