What is the key question?

• Empyema is associated with low rates of positive microbial culture. Could this be because we are looking in the wrong place and culturing the wrong material?

What is the bottom line?

• Positive culture rates in empyema are consistently only around 45% in cases of pneumonia associated pleural infection.
• Subsequently antibiotic treatment is empirical in most cases and based on local antimicrobial guidelines and judgement. This may lead to treatment failure and surgical intervention which is associated with higher morbidity.
• The authors test the theory that pleural biopsies give better results on culture than pleural fluid by investigating the safety and feasibility of ultrasound guided pleural biopsy as a diagnostic tool in pleural infection.

Why read on?

• Pleural culture showed 2.5-4.5 fold increase in diagnostic yield when compared to pleural fluid and blood culture (45% vs 20% and 10%) in a group of 20 patients.
• An interesting observation was that 75% of patients with positive pleural culture were already receiving antibiotics.
• There were no adverse events in the pleural biopsy group but accuracy of ultrasound guided pleural biopsy is a skill with a learning curve that will likely require some training and practice to ensure reliable results.