You're getting treatment for pneumonia, but instead of getting better, you're getting worse. The fevers won't go away, the chest pain gets worse, and your shortness of breath is worse than ever. This is a very important sign that the infection may have gotten worse and turned into an empyema, which is a collection of pus in the space around your lung. If you have an empyema, you need to go to the hospital right away because it is a medical emergency that could kill you. Having a careful medical partner who treats your first case of pneumonia aggressively and quickly if you don't get better is the key to avoiding it. This is where Direct Primary Care (DPC) can make a life-saving difference by being proactive and easy to get to.
An empyema is a thick, infected fluid collection, or pus, that builds up in the pleural space, which is the thin area between the outside of the lung and the inside of the chest wall.
How it Grows:
Most of the time, it is a complication of bacterial pneumonia. While the lung fights the infection, fluid can build up in the pleural space. This is called a parapneumonic effusion. If bacteria get into that fluid, it can turn into pus, which makes an empyema, a contained, abscess-like infection.
A Medical Emergency:
An empyema is an infection that is very bad. It puts about 32,000 people in the hospital each year in the United States, and the death rate can be as high as 15%.
The Cornerstones of Treatment (in the hospital): The treatment of empyema is always done in a hospital and is very aggressive. There are two main parts to it:
Antibiotics given through an IV to fight the infection in the body.
Draining: The pus must be removed from the chest, usually by putting a chest tube through the chest wall or, in more complicated cases, by surgery.
Warning: Direct Primary Care doctors do not treat empyema that is already there. This is a medical emergency that needs to be treated right away with IV antibiotics and a chest tube. DPC plays an important role in aggressively treating pneumonia to stop empyema from ever forming and in organizing recovery after a hospital stay. This is why DPC is the best option for this situation:
Prevention Through Strong Management of Pneumonia:
This is the most important thing your DPC doctor does to save your life.
Quick Access and Treatment: If you start to show signs of pneumonia, your DPC doctor can see you and treat you the same day.
Close, all the time Follow-up: This is the most important thing you can do to avoid problems. A DPC doctor doesn't just give you a prescription and hope you get better. Within 48 hours, they will want you to check in by phone or text. If you aren't getting better as expected, they will ask you to come back right away for another evaluation.
Finding problems early: This close follow-up lets your doctor see the first signs of a parapneumonic effusion that is getting worse before it turns into a full-blown empyema. This leads to a timely, non-emergency hospital referral for treatment, which can stop a much worse illness from happening.
A "Medical Home" for Recovery After the Hospital:
It takes a long time to get better after being in the hospital for an empyema. Your DPC doctor is where you go for help.
They help you switch from IV antibiotics to oral antibiotics.
They take care of your follow-up visits with thoracic surgeons or lung specialists (pulmonology).
They help you get better with your diet and slowly get back to doing the things you normally do.
Preventive care that is proactive:
Your DPC doctor makes sure that patients who are at risk, like older adults and those with chronic lung disease, always get all of their important vaccinations, such as the pneumococcal vaccines (Prevnar and Pneumovax), to help keep them from getting serious pneumonia in the first place.
Case 1 (Prevention): David, who is 70 years old, sees his DPC doctor and is told he has community-acquired pneumonia. He is given antibiotics. The doctor tells him to text her every day to let her know how his breathing and temperature are doing. David says on day three that his fever is still high and he is having trouble breathing. The doctor wants him to come in right away. A chest X-ray shows that there is a new pleural effusion. The DPC doctor knows that this is a complicated case of pneumonia that could get worse and turn into empyema. To stop this from happening, the doctor calls the local hospitalist and sets up a direct admission.
Case 2 (Recovery): Linda, 60, was in the hospital for two weeks because of an empyema that needed a chest tube. She is now out of the hospital. Two days later, her DPC doctor sees her for a long, one-hour follow-up visit. The doctor carefully goes over all of her new medications, the complicated discharge plan, her severe fatigue and nutritional needs, and makes a clear, organized plan for her recovery that will last for months.
Q: I have pneumonia. How can I tell if it's getting worse, like an empyema?
A: The most important sign that something is wrong is that you are not getting better as expected after 48 to 72 hours of taking the right antibiotic. If your fever doesn't go down or gets worse, or if your chest pain or shortness of breath gets worse instead of better, you need to call your doctor right away. The close follow-up that a DPC doctor does is meant to catch this kind of thing.
Q: Do I really need surgery for an empyema?
A: You will always need to have the pus drained from your chest. An interventional radiologist or a hospitalist can often do this at the bedside with a chest tube for many patients. A thoracic surgeon may need to do a more invasive surgery to clean out the space if the pus is very thick or has formed multiple pockets (loculations).
Q: What is DPC's most important job in relation to this very bad infection?
A: Preventing by giving care that is both proactive and responsive. A DPC doctor can often step in and get you to a higher level of care before a simple pneumonia has the chance to turn into a life-threatening empyema by treating community-acquired pneumonia aggressively from day one and keeping a very close eye on you to make sure you are getting better.
DPC has a clear advantage when it comes to treating pneumonia and avoiding its worst complications: it prevents complications through close pneumonia.
Follow-Up: DPC's ability to stay in touch and get to you quickly are the best ways to make sure that pneumonia is responding to treatment and to step in early if it isn't.
Helping with quick triage to the hospital: A DPC doctor can spot the early signs of an empyema and help you get to the hospital quickly and efficiently.
Giving full care after leaving the hospital: Being the best "home base" for managing the long and complicated recovery after a patient survives an empyema.
You should do everything you can to avoid getting an empyema, which is a very bad complication of pneumonia. The key is to have a medical partner who is very careful and treats your pneumonia aggressively while keeping a close eye on you to make sure you are getting better. Direct Primary Care offers a responsive, ongoing, and proactive partnership to help you avoid this dangerous infection and get better if you do get it.
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