Intrapleural Gentian Violet Irrigation for Refractory Methicillin‐Resistant <scp> <i>Staphylococcus aureus</i> </scp> Empyema: A Case Series

ABSTRACT Methicillin‐resistant Staphylococcus aureus (MRSA) empyema remains challenging despite guideline‐based management. Gentian violet (GV), an antiseptic dye, has been sporadically used for MRSA infections but not systematically evaluated in pleural disease. We analysed nine consecutive patients with MRSA empyema treated with intrapleural GV irrigation following surgical debridement between 2011 and 2018. All patients successfully completed GV irrigation without procedural complications. Bacterial clearance was achieved within a median of 5 days (IQR, 4–8), which was within the range observed in the non‐MRSA cohort treated with saline lavage (13 days [IQR, 6–24]). No GV‐related adverse events occurred during a median follow‐up of 993 days. Three patients developed Pseudomonas aeruginosa superinfection, likely reflecting GV's limited Gram‐negative activity. This case series demonstrates that intrapleural GV irrigation is feasible and safe, achieving microbiological clearance within an acceptable timeframe for MRSA empyema.