11th January 2024

A 69-year-old gentleman with a history of alcohol excess and homelessness is being treated for a pleural infection on a respiratory ward.

A 69-year-old gentleman with a history of alcohol excess and homelessness is being treated for a pleural infection on a respiratory ward. He has a chest drain in situ, which has been draining frankly purulent pleural fluid for the past 5 days and has significantly slowed in the last 24 hours. He remains on intravenous antibiotics as guided by local microbiologists. Despite this, he continues to spike regular temperatures.

Investigations: 

Serum WCC 35.1 x 10*9    (4.0-11.0) – previously 12.9 48 hours ago. 

Serum CRP 389                 (<10) – previously 197 48 hours ago. 

What is the next most appropriate management strategy? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.