Community-acquired pleural infection in a patient without penicillin allergy, where the initial course of medical management with intrapleural fibrinolytic therapy (IPFT) has not produced sufficient radiographic clearance or drainage of the infected pleural space.
The previous treatment — intrapleural fibrinolytic therapy (IPFT) — did not meet its goals of improvement in radiographic clearance and effective drainage of the infected pleural space. Failure to reach these targets is the trigger for escalation to the next management step.
Surgical intervention is indicated. The operative approach is directed at debridement and evacuation of infected material from the pleural cavity, with the specific technique depending on disease stage and patient factors. The complete decision pathway — including which approach applies when — is in the full structured protocol.
Lung re-expansion and maintenance of a sterile pleural space.