Management of Pleural Space Infections

Inclusion Criteria: * Age \>18 years * Clinical presentation compatible with pleural infection (fever or leukocytosis, elevated procalcitonin, elevated C-reactive protein (CRP)) * Pleural fluid requiring drainage that is either: * Macroscopically purulent or * Positive on culture for bacterial infection or * Positive for bacteria on gram stain or * Lactate dehydrogenase (LDH) \> 1000 IU/L or * Glucose \<40 mg/dL Exclusion Criteria: * Age \<18 years * Unable to give consent (No surrogate consent of legally authorized representatives allowed for this study) * Not proficient in English * History of prior ipsilateral empyema * Has known sensitivity to DNase or alteplase * History of intracranial hemorrhage or acute intracranial hemorrhage * History of stroke, hemorrhage, or trauma within the last 3 months * Has had prior surgery on the side of the pleural infection * Patients who are pregnant or lactating * Expected survival less than 6 months from a different pathology to this pleural infection based on clinical judgment * Has a tunneled pleural catheter in place * Patients on anticoagulation that cannot be interrupted for surgical intervention * Patients with known or suspected malignant pleural effusion * Patients with renal failure (Creatinine clearance \<30) * Prior history of or concern for chylothorax or pseudochylothorax * Vulnerable populations: prisoners