While empyema has historically been a surgical disease, more recent randomized clinical trial has suggested the use of intrapleural therapy with a combination of a direct-acting fibrinolytic agent (recombinant tissue plasminogen activator) and a hydrolytic enzyme of DNA (deoxyribonuclease) improves radiographic and clinical outcomes (including the need for surgical referral) in patients with complicated pleural space infections [18]. This evidence concerns the gene PLAT and empyema.