Empyema Thoracis Caused by Drug-Resistant Staphylococcus aureus in an Adult Female: A Case Report

Abstract

Empyema thoracis, which is the collection of pus in the pleural cavity, has been experiencing an increase in incidence rate in both adults and children. When present, it is most often a complication of some cases of pneumonia, but a proportion may result from iatrogenic causes or develop without pneumonia. It, therefore, constitutes a significant management challenge. In the case of bacteria resistant to conventional antibiotics, management of this potentially fatal complication may be difficult and is often associated with high morbidity and mortality (ranging from 6% to 24%). We herein report a case of empyema thoracis caused by drug-resistant Staphylococcus aureus in an adult female. We report the case of a 28-year-old woman of black ethnicity who presented to the outpatient department with a 3-week history of unproductive cough, sharp right-sided chest pain, shortness of breath, and easy fatigability. Physical examination revealed signs of right lung consolidation, and chest X-ray showed a massive right pleural effusion with fluid analysis revealing of a purulent exudate and gram positive cocci in clusters, which was managed with cloxacillin. Culture had growth of multidrug-resistant S. aureus sensitive to clindamycin. A definitive diagnosis of empyema thoracis was made and treated with potent antibiotics and chest tube drainage with an initial positive outcome. There was a relapse a week later at the follow-up visit, necessitating further antibiotherapy and associations. Empyema thoracis is a common complication, though not always, of longstanding pneumonia with S. aureus as one of the main causative agents. However, the resistance of this pathogen to conventional antibiotics probably due to longstanding self-medication makes management delicate/difficult, as in this case. We, therefore, recommend aggressive management, combining pus draining and intravenous anti-biotherapy, especially in this era of growing bacterial resistance to antibiotics.