RARE DISEASE
Pleural empyema
Pleural empyema
Pleural empyema
Drug discovery
2
drugs
With orphan designations
Overview
Pleural empyema, a collection of pus in the pleural space, typically arises from complications of pneumonia, thoracic procedures, or trauma. It progresses through exudative, fibrinopurulent, and organized stages, causing symptoms like chest pain, fever, and respiratory compromise [1][6][11]. Diagnosis involves imaging and pleural fluid analysis, while treatment combines antibiotics, drainage (thoracentesis/chest tubes), intrapleural fibrinolytics, and surgery (VATS/decortication) for advanced cases [3][8][13]. Mortality ranges from 6.9% to 16.1%, with rising incidence linked to aging populations and influenza [4][12][17].
Population
Incidence rising globally, particularly in elderly males and those with comorbidities (diabetes, COPD, asthma) [4][9][17].
Seasonal correlation with influenza peaks, especially in children and young adults [14][19].
Higher risk in patients with poor dental hygiene, immunosuppression, or thoracic trauma [5][7][11].
Therapies
Early-stage: Antibiotics + image-guided thoracentesis or small-bore chest tubes [1][13].
Loculated effusions: Intrapleural fibrinolytic therapy (e.g., alteplase/DNase) to enhance drainage [8][13].
Advanced cases: VATS or open decortication for lung re-expansion, achieving 83-98% success rates [3][17][12].
Categories: rare respiratory diseases
Research Papers
1,849 drug discovery papers about Pleural empyema, with 2 first-in-class and 1 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
1,849 drug discovery papers about Pleural empyema, with 2 first-in-class and 1 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
2026-08-12 | Role of omental flaps in thoracic surgery complications: a narrative review.
The greater omentum is a highly vascularized and immunologically active organ with recognized regenerative and antimicrobial properties. Its application in pleural space complications has gained renewed interest with the expansion of minimally invasive harvesting techniques. This review summarizes the current literature regarding the role of omental flaps in the management of post-lobectomy complications. This narrative review was conducted using a comprehensive search of MEDLINE (Via PubMed), Scopus, and Cochrane Central Register of Controlled Trials from database inception through February 2026 using the search terms "Omental flap", "pleural space", and "bronchopleural fistula", "post-lobectomy complications", "entrapped lung" and "empyema". Peer-reviewed articles in English and Spanish were included. Data were extracted and synthesized narratively, focusing on indications, techniques, outcomes, advantages, and limitations. Omental flaps are most used for bronchopleural fistula (BPF), empyema, mediastinitis, and prosthetic graft coverage. Rich vascular and lymphatic networks of the omentum enhance infection control and tissue healing, particularly in contaminated or high-risk fields. The size and pliability of the omentum allow effective obliteration of complex pleural dead space problems and durable coverage of critical structures. Reported flap survival rates range from 80-100% in small case series. Omental flaps represent a versatile and biologically advantageous option for pleural space complications. Although current evidence is limited and largely observational, reported outcomes are promising, warranting further prospective investigation.
2026-08-07 | Pediatric pyopneumothorax caused by Prevotella oris successfully diagnosed via mNGS: a case report and literature review.
Empyema and pyopneumothorax are severe complications of pediatric community-acquired pneumonia. While typically caused by aerobic bacteria, anaerobic infections, particularly those involving Prevotella oris (P. oris), are exceedingly rare in children. This study aims to explore the clinical characteristics, diagnostic challenges, and therapeutic strategies for pediatric pyopneumothorax caused by P. oris, thereby enhancing clinical awareness of this uncommon opportunistic pathogen. We retrospectively analyzed the clinical data of a 10-year-old male admitted to the Hebei Children's Hospital in October 2025, presenting with acute chest pain and a history of tooth extraction 1 week prior to symptom onset. Radiological imaging revealed bilateral pneumonia with bilateral pleural effusions (predominantly on the left side). Pleural fluid analysis was consistent with an empyema. Traditional bacterial cultures of blood and pleural fluid yielded negative results. However, probe-based targeted metagenomic next-generation sequencing (mNGS) of the pleural fluid identified P. oris with a high relative abundance (81.86%), alongside other minor oral commensals. Based on the molecular diagnosis and the patient's ongoing clinical deterioration, cefoperazone-sulbactam was selected to strengthen coverage against anaerobic Gram-negative organisms, while linezolid was temporarily added to cover potential Gram-positive pleural co-infection during the acute deterioration phase. This was combined with closed thoracic drainage and intrapleural urokinase instillation for fibrinolysis, leading to a complete clinical recovery. Prevotella oris is a rare but significant pathogen in pediatric empyema. A high index of suspicion should be maintained for anaerobic infections in children presenting with a history of dental procedures, abnormal immune parameters or possible immunological vulnerability, or poor response to empirical antibiotics. Traditional cultures are often inadequate; therefore, mNGS serves as a crucial tool for the early detection and precise treatment of difficult-to-culture anaerobes.
2026-07-20 | Intrapleural Fibrinolytic Therapy in the Management of Pediatric Pleural Empyema: A Narrative Review
Background: Pediatric pleural empyema is a major complication of community-acquired pneumonia and remains associated with substantial morbidity despite advances in vaccination, antimicrobial therapy, and supportive care. Intrapleural fibrinolytic therapy has become an important minimally invasive treatment for complicated parapneumonic effusions and empyema, but uncertainty persists regarding the optimal fibrinolytic agent, treatment protocols, patient selection, and indications for surgical intervention. Methods: A narrative review of the literature was conducted to summarize current evidence on the use of intrapleural fibrinolytic therapy in pediatric pleural empyema. Experimental studies, randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international clinical practice guidelines were critically reviewed. Particular attention was paid to the biological rationale for fibrinolysis, pharmacological characteristics of available agents, comparative effectiveness with video-assisted thoracoscopic surgery (VATS), practical treatment protocols, safety, and future research priorities. Results: Intrapleural fibrinolysis effectively improves pleural drainage by lysing fibrin septations during the fibrinopurulent stage of empyema and is associated with shorter hospitalization compared with chest-tube drainage alone. Urokinase remains the fibrinolytic agent supported by the highest-quality pediatric randomized evidence, whereas alteplase has demonstrated favorable outcomes in observational studies and randomized comparisons with VATS. Current evidence indicates comparable clinical outcomes between fibrinolysis and primary VATS in appropriately selected children, although fibrinolysis is generally associated with lower treatment costs and avoidance of surgery in most patients. Conventional-dose fibrinolytic therapy has an acceptable safety profile, with clinically significant bleeding reported only rarely. Current pediatric evidence does not support the routine addition of DNase to tissue plasminogen activator. Conclusion: Intrapleural fibrinolytic therapy represents a safe, effective, and minimally invasive first-line treatment for most children with complicated parapneumonic effusions and pleural empyema requiring drainage. Management should be individualized within a multidisciplinary framework, integrating timely diagnosis, image-guided pleural drainage, appropriate antimicrobial therapy, and selective surgical intervention. Future multicenter studies are needed to optimize fibrinolytic protocols, validate predictive biomarkers, and further standardize clinical management.
2026-07-15 | Adult Empyema Caused by Refractory Methicillin-Resistant Staphylococcus aureus Treated Using Linezolid as Salvage Therapeutic Option: A Report of Two Cases.
The pathogenesis and treatment of pulmonary lesions caused by methicillin-resistant Staphylococcus aureus (MRSA) infection have been unclear because MRSA has usually been considered a colonizer. Two adult cases of MRSA empyema were treated using linezolid (LZD) because they were refractory to the glycopeptides vancomycin (VCM) and teicoplanin (TEIC). Case 1 was a 50-year-old man with a history of lung cancer and pneumothorax who was admitted with pulmonary empyema with a severe dry cough. MRSA empyema was diagnosed because only MRSA was detected by video-assisted thoracoscopy (VATS) from his effusions. He was initially treated using VCM for 10 days, but his inflammatory markers and condition did not so improve; therefore, VCM was switched to LZD. His condition improved with LZD for 14 days. Case 2 was a 77-year-old man with pharyngeal cancer who was admitted with respiratory failure. He was diagnosed with MRSA empyema because only MRSA was detected from his pleural effusions on pleural drainage. He received a TEIC drip infusion for 10 days, but his respiratory status did not so improve; therefore, his treatment was switched to LZD. His condition improved with LZD for 14 days. MRSA empyema was diagnosed in these two cases because only MRSA was detected from pleural effusions. Both patients finally improved following the switch from glycopeptide antibiotics to LZD. These findings suggest MRSA as the true cause of the infections and that LZD, rather than VCM and TEIC, might be effective in cases of MRSA empyema.
2026-07-06 | Metagenomic Analysis of Thoracic Empyema Etiology Through Next-Generation Sequencing Enhances Conventional Culture Techniques.
This study aimed to analyze the microbiome of thoracic empyema using metagenomic methods and compare the results with conventional culture methods to increase diagnostic accuracy and enhance antibiotic therapy. This study involved 30 patients with thoracic empyema from hospitals in Riau Province, Indonesia. Pleural fluid samples were collected for culture analysis and identification using the Vitek 2 compact system and metagenomic analysis. Patient clinical data were also collected. Culture methods showed a 40.0% positive rate, with Gram-negative bacteria (Klebsiella pneumoniae and Pseudomonas aeruginosa) predominating. Metagenomics showed a 56.7% positive rate, identifying a more diverse microbiome, including fungi (29.4% abundance), other Gram-negative bacteria (26.5%), and anaerobic bacteria (22.5%). Comparison of the two methods showed 36.7% complete agreement and 23.3% partial agreement, with 40% disagreement, with a Kappa coefficient of 0.416 and P-value of 0.016 (P<0.050). Metagenomic NGS offers significant advantages in detecting the microbiome of thoracic empyema, particularly fungi and anaerobic bacteria, which are often missed by conventional culture methods. This has the potential to improve diagnostic accuracy and optimize antibiotic therapy. Further research with larger sample sizes is needed.
2026-08-12 | Role of omental flaps in thoracic surgery complications: a narrative review.
The greater omentum is a highly vascularized and immunologically active organ with recognized regenerative and antimicrobial properties. Its application in pleural space complications has gained renewed interest with the expansion of minimally invasive harvesting techniques. This review summarizes the current literature regarding the role of omental flaps in the management of post-lobectomy complications. This narrative review was conducted using a comprehensive search of MEDLINE (Via PubMed), Scopus, and Cochrane Central Register of Controlled Trials from database inception through February 2026 using the search terms "Omental flap", "pleural space", and "bronchopleural fistula", "post-lobectomy complications", "entrapped lung" and "empyema". Peer-reviewed articles in English and Spanish were included. Data were extracted and synthesized narratively, focusing on indications, techniques, outcomes, advantages, and limitations. Omental flaps are most used for bronchopleural fistula (BPF), empyema, mediastinitis, and prosthetic graft coverage. Rich vascular and lymphatic networks of the omentum enhance infection control and tissue healing, particularly in contaminated or high-risk fields. The size and pliability of the omentum allow effective obliteration of complex pleural dead space problems and durable coverage of critical structures. Reported flap survival rates range from 80-100% in small case series. Omental flaps represent a versatile and biologically advantageous option for pleural space complications. Although current evidence is limited and largely observational, reported outcomes are promising, warranting further prospective investigation.
2026-08-07 | Pediatric pyopneumothorax caused by Prevotella oris successfully diagnosed via mNGS: a case report and literature review.
Empyema and pyopneumothorax are severe complications of pediatric community-acquired pneumonia. While typically caused by aerobic bacteria, anaerobic infections, particularly those involving Prevotella oris (P. oris), are exceedingly rare in children. This study aims to explore the clinical characteristics, diagnostic challenges, and therapeutic strategies for pediatric pyopneumothorax caused by P. oris, thereby enhancing clinical awareness of this uncommon opportunistic pathogen. We retrospectively analyzed the clinical data of a 10-year-old male admitted to the Hebei Children's Hospital in October 2025, presenting with acute chest pain and a history of tooth extraction 1 week prior to symptom onset. Radiological imaging revealed bilateral pneumonia with bilateral pleural effusions (predominantly on the left side). Pleural fluid analysis was consistent with an empyema. Traditional bacterial cultures of blood and pleural fluid yielded negative results. However, probe-based targeted metagenomic next-generation sequencing (mNGS) of the pleural fluid identified P. oris with a high relative abundance (81.86%), alongside other minor oral commensals. Based on the molecular diagnosis and the patient's ongoing clinical deterioration, cefoperazone-sulbactam was selected to strengthen coverage against anaerobic Gram-negative organisms, while linezolid was temporarily added to cover potential Gram-positive pleural co-infection during the acute deterioration phase. This was combined with closed thoracic drainage and intrapleural urokinase instillation for fibrinolysis, leading to a complete clinical recovery. Prevotella oris is a rare but significant pathogen in pediatric empyema. A high index of suspicion should be maintained for anaerobic infections in children presenting with a history of dental procedures, abnormal immune parameters or possible immunological vulnerability, or poor response to empirical antibiotics. Traditional cultures are often inadequate; therefore, mNGS serves as a crucial tool for the early detection and precise treatment of difficult-to-culture anaerobes.
2026-07-20 | Intrapleural Fibrinolytic Therapy in the Management of Pediatric Pleural Empyema: A Narrative Review
Background: Pediatric pleural empyema is a major complication of community-acquired pneumonia and remains associated with substantial morbidity despite advances in vaccination, antimicrobial therapy, and supportive care. Intrapleural fibrinolytic therapy has become an important minimally invasive treatment for complicated parapneumonic effusions and empyema, but uncertainty persists regarding the optimal fibrinolytic agent, treatment protocols, patient selection, and indications for surgical intervention. Methods: A narrative review of the literature was conducted to summarize current evidence on the use of intrapleural fibrinolytic therapy in pediatric pleural empyema. Experimental studies, randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international clinical practice guidelines were critically reviewed. Particular attention was paid to the biological rationale for fibrinolysis, pharmacological characteristics of available agents, comparative effectiveness with video-assisted thoracoscopic surgery (VATS), practical treatment protocols, safety, and future research priorities. Results: Intrapleural fibrinolysis effectively improves pleural drainage by lysing fibrin septations during the fibrinopurulent stage of empyema and is associated with shorter hospitalization compared with chest-tube drainage alone. Urokinase remains the fibrinolytic agent supported by the highest-quality pediatric randomized evidence, whereas alteplase has demonstrated favorable outcomes in observational studies and randomized comparisons with VATS. Current evidence indicates comparable clinical outcomes between fibrinolysis and primary VATS in appropriately selected children, although fibrinolysis is generally associated with lower treatment costs and avoidance of surgery in most patients. Conventional-dose fibrinolytic therapy has an acceptable safety profile, with clinically significant bleeding reported only rarely. Current pediatric evidence does not support the routine addition of DNase to tissue plasminogen activator. Conclusion: Intrapleural fibrinolytic therapy represents a safe, effective, and minimally invasive first-line treatment for most children with complicated parapneumonic effusions and pleural empyema requiring drainage. Management should be individualized within a multidisciplinary framework, integrating timely diagnosis, image-guided pleural drainage, appropriate antimicrobial therapy, and selective surgical intervention. Future multicenter studies are needed to optimize fibrinolytic protocols, validate predictive biomarkers, and further standardize clinical management.
2026-07-15 | Adult Empyema Caused by Refractory Methicillin-Resistant Staphylococcus aureus Treated Using Linezolid as Salvage Therapeutic Option: A Report of Two Cases.
The pathogenesis and treatment of pulmonary lesions caused by methicillin-resistant Staphylococcus aureus (MRSA) infection have been unclear because MRSA has usually been considered a colonizer. Two adult cases of MRSA empyema were treated using linezolid (LZD) because they were refractory to the glycopeptides vancomycin (VCM) and teicoplanin (TEIC). Case 1 was a 50-year-old man with a history of lung cancer and pneumothorax who was admitted with pulmonary empyema with a severe dry cough. MRSA empyema was diagnosed because only MRSA was detected by video-assisted thoracoscopy (VATS) from his effusions. He was initially treated using VCM for 10 days, but his inflammatory markers and condition did not so improve; therefore, VCM was switched to LZD. His condition improved with LZD for 14 days. Case 2 was a 77-year-old man with pharyngeal cancer who was admitted with respiratory failure. He was diagnosed with MRSA empyema because only MRSA was detected from his pleural effusions on pleural drainage. He received a TEIC drip infusion for 10 days, but his respiratory status did not so improve; therefore, his treatment was switched to LZD. His condition improved with LZD for 14 days. MRSA empyema was diagnosed in these two cases because only MRSA was detected from pleural effusions. Both patients finally improved following the switch from glycopeptide antibiotics to LZD. These findings suggest MRSA as the true cause of the infections and that LZD, rather than VCM and TEIC, might be effective in cases of MRSA empyema.
2026-07-06 | Metagenomic Analysis of Thoracic Empyema Etiology Through Next-Generation Sequencing Enhances Conventional Culture Techniques.
This study aimed to analyze the microbiome of thoracic empyema using metagenomic methods and compare the results with conventional culture methods to increase diagnostic accuracy and enhance antibiotic therapy. This study involved 30 patients with thoracic empyema from hospitals in Riau Province, Indonesia. Pleural fluid samples were collected for culture analysis and identification using the Vitek 2 compact system and metagenomic analysis. Patient clinical data were also collected. Culture methods showed a 40.0% positive rate, with Gram-negative bacteria (Klebsiella pneumoniae and Pseudomonas aeruginosa) predominating. Metagenomics showed a 56.7% positive rate, identifying a more diverse microbiome, including fungi (29.4% abundance), other Gram-negative bacteria (26.5%), and anaerobic bacteria (22.5%). Comparison of the two methods showed 36.7% complete agreement and 23.3% partial agreement, with 40% disagreement, with a Kappa coefficient of 0.416 and P-value of 0.016 (P<0.050). Metagenomic NGS offers significant advantages in detecting the microbiome of thoracic empyema, particularly fungi and anaerobic bacteria, which are often missed by conventional culture methods. This has the potential to improve diagnostic accuracy and optimize antibiotic therapy. Further research with larger sample sizes is needed.
Access all drug discovery papers and probability of success in trials forecasts:
Access all drug discovery papers and probability of success in trials forecasts:
Drug Discovery Landscape
2 orphan drug designations for Pleural empyema.
2 orphan drug designations for Pleural empyema.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
Single-chain urokinase plasminogen activator | proteins | EMA | 2014-12-16 | — | Scendea (NL) B.V. |
single chain urokinase plasminogen activator | proteins | FDA | 2014-09-11 | — | Lung Therapeutics, Inc. |
Let's accelerate rare disease drug discovery
Let's accelerate drug discovery
Get access to Explority AI's forecasts to outperform average preclinical success rates. Whether you're expanding your R&D pipeline, evaluating a partnership, or simply have a question — we'd love to hear from you.