A study investigating indwelling-pleural catheter-related pleural infection rates at a District General Hospital

Lung Cancer ◽  
2018 ◽  
Vol 115 ◽  
pp. S78
Author(s):  
S. Alaee ◽  
A. Stanton
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Infection Rates ◽  
Indwelling Pleural Catheter ◽  
Pleural Infection ◽  
Pleural Catheter

Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Deirdre B. Fitzgerald ◽  
Sanjeevan Muruganandan ◽  
Selina Tsim ◽  
Hugh Ip ◽  
Rachelle Asciak ◽  
...  
Keyword(s):  
Post Infection ◽  
Thoracoscopic Surgery ◽  
Major Morbidity ◽  
Indwelling Pleural Catheter ◽  
Tissue Plasminogen ◽  
Pleural Infection ◽  
Malignant Effusions ◽  
The Mean ◽  
Pleural Catheter ◽  
Gram Negative Organisms

<b><i>Background:</i></b> Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce. <b><i>Objective:</i></b> To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection. <b><i>Methods:</i></b> Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on <i>feasibility</i> of intrapleural tPA/DNase delivery, its <i>efficacy</i> and <i>safety</i> were recorded. <b><i>Results:</i></b> Thirty-nine IPC-related pleural infections (predominantly <i>Staphylococcus aureus</i> and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3–6]/patient) of tPA (2.5 mg–10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding. <b><i>Conclusion:</i></b> Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.

scholarly journals A Case of Empyema and a Review of Practice in a District General Hospital

2019 ◽  
Keyword(s):  
Antibiotic Therapy ◽  
General Hospital ◽  
District General Hospital ◽  
Pleural Space ◽  
Immunosuppressed Patient ◽  
Case Review ◽  
Pleural Infection

The authors describe an empyema in an immunosuppressed patient. Thoracentesis was attempted and only 60 mL of pus was obtained from her pleural space. She was treated as an outpatient with antibiotic therapy. The authors have recently performed a review of all cases of pleural infection between December 2016 and December 2017 in their trust, of which there were 36. Here, they describe failings that have now been addressed and which helped in managing this particular case. As a result of this review, the authors have developed a pleural procedure form that encompasses all of the recommendations from their case review.

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