An international survey on the use of intrapleural tPA/DNase therapy for pleural infection

IntroductionIntrapleural tissue plasminogen activator (tPA) combined with human recombinant DNase (DNase) could be an effective alternative to surgery in managing pleural infection as demonstrated in the Multi-centre Intrapleural Sepsis Trial (MIST)-2. However, the optimal delivery regime is still unknown. The aim of this survey is to identify the current practice of tPA/DNase use by physicians with published interests in pleural infection, and their opinions on dose de-escalation of tPA/DNase therapy.MethodsPotential participants were identified using four search strategies. Only practicing physicians who are managing patients with pleural infections and are either actively involved in pleural research and publications, or members of relevant pleural disease guideline panels at the time of survey were included.ResultsAn invitation email with the questionnaire was sent to 102 participants of which 49 (48%) responded. Most respondents (90%, n=44) have used tPA/DNase to manage pleural infection but the dosing and delivery regimens employed varied. Many (86%, n=38/44) respondents have used 10 mg tPA, while 73% (n=32), 16%, (n=7) and 9% (n=4) have used 5 mg, 2.5 mg and 1 mg doses respectively. Most respondents instilled tPA/DNase concurrently (61%, n=27) and routinely administered 6 doses of tPA/DNase (52%, n=23) twice daily (82%, n=36). Respondents would consider using a lower starting dose of tPA (with the possibility of escalation if clinically needed) if 80% [IQR 50–80] of patients could be successfully treated at that dose.ConclusionThis survey observed a large variation in the current treatment protocol of intrapleural tPA/DNase therapy worldwide and the need for more data on this subject.

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Critical review of the current management of pleural infection in a UK district general hospital. Applying the MIST II (multicentre intrapleural sepsis trial) evidence to our current practice

10.1183/13993003.congress-2016.pa602 ◽

2016 ◽

Author(s):

Benjamin Peirce ◽

Thomas Pulimood ◽

Clare Harris

Keyword(s):

General Hospital ◽

Critical Review ◽

Current Practice ◽

District General Hospital ◽

Current Management ◽

Pleural Infection ◽

Trial Evidence ◽

Sepsis Trial

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Management of Prehemorrhage Antiplatelet Use in Aneurysmal Subarachnoid Hemorrhage: An International Survey of Current Practice

10.1055/s-0038-1660765 ◽

2018 ◽

Author(s):

M. Sebök ◽

E. Keller ◽

B. van Niftrik ◽

L. Regli ◽

M.R. Germans

Keyword(s):

Subarachnoid Hemorrhage ◽

Current Practice ◽

Aneurysmal Subarachnoid Hemorrhage ◽

International Survey

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Faculty Opinions recommendation of Intrapleural use of tissue plasminogen activator and DNase in pleural infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717948970.793453162 ◽

2012 ◽

Author(s):

Jonathon Truwit

Keyword(s):

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

Pleural Infection

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Novel therapeutic interventions towards improved management of septic arthritis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04383-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jian Wang ◽

Liucai Wang

Keyword(s):

Antibiotic Therapy ◽

Septic Arthritis ◽

Clinical Success ◽

Treatment Protocol ◽

Current Treatment ◽

Therapeutic Interventions ◽

Medical Emergency ◽

Success Rates ◽

Joint Infections ◽

Novel Therapeutic

AbstractSeptic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

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Current practice and perceptions of safety protocols for the use of intraperitoneal chemotherapy in the operating room: results of the IP-OR international survey

Pleura and Peritoneum ◽

10.1515/pp-2020-0148 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Daniel Clerc ◽

Martin Hübner ◽

K.R. Ashwin ◽

S.P. Somashekhar ◽

Beate Rau ◽

...

Keyword(s):

Operating Room ◽

Intraperitoneal Chemotherapy ◽

Current Practice ◽

High Volume ◽

International Survey ◽

Protection Measures ◽

Team Members ◽

Cleaning Staff ◽

The Individual ◽

Or Team

Abstract Objectives To assess the risk perception and the uptake of measures preventing environment-related risks in the operating room (OR) during hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods A multicentric, international survey among OR teams in high-volume HIPEC and PIPAC centers: Surgeons (Surg), Scrub nurses (ScrubN), Anesthesiologists (Anest), Anesthesiology nurses (AnesthN), and OR Cleaning staff (CleanS). Scores extended from 0–10 (maximum). Results Ten centers in six countries participated in the study (response rate 100%). Two hundred and eleven responses from 68 Surg (32%), 49 ScrubN (23%), 45 Anest (21%), 31 AnesthN (15%), and 18 CleanS (9%) were gathered. Individual uptake of protection measures was 51.4%, similar among professions and between HIPEC and PIPAC. Perceived levels of protection were 7.57 vs. 7.17 for PIPAC and HIPEC, respectively (p<0.05), with Anesth scoring the lowest (6.81). Perceived contamination risk was 4.19 for HIPEC vs. 3.5 for PIPAC (p<0.01). Information level was lower for CleanS and Anesth for HIPEC and PIPAC procedures compared to all other responders (6.48 vs. 4.86, and 6.48 vs. 5.67, p<0.01). Willingness to obtain more information was 86%, the highest among CleanS (94%). Conclusions Experience with the current practice of safety protocols was similar during HIPEC and PIPAC. The individual uptake of protection measures was rather low. The safety perception was better for PIPAC, but the perceived level of protection remained relatively low. The willingness to obtain more information was high. Intensified, standardized training of all OR team members involved in HIPEC and PIPAC is meaningful.

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CT appearances of pleural infection: analysis of the Second Multi-centre Intra-pleural Sepsis Trial (MIST 2) cohort

Clinical Radiology ◽

10.1016/j.crad.2020.12.017 ◽

2021 ◽

Author(s):

J. Franklin ◽

A. Talwar ◽

D. Addala ◽

E.J. Helm ◽

R. Benamore ◽

...

Keyword(s):

Pleural Infection ◽

Sepsis Trial

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Early Description of Coronavirus 2019 Disease in Kidney Transplant Recipients in New York

Journal of the American Society of Nephrology ◽

10.1681/asn.2020030375 ◽

2020 ◽

Vol 31 (6) ◽

pp. 1150-1156 ◽

Cited By ~ 80

Author(s):

Keyword(s):

New York ◽

Kidney Transplant ◽

Severe Disease ◽

Treatment Protocol ◽

Current Treatment ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Radiographic Findings ◽

Increased Risk

BackgroundThe novel SARS-CoV-2 virus has caused a global pandemic of coronavirus disease 2019 (COVID-19). Although immunosuppressed individuals are thought to be at an increased risk of severe disease, little is known about their clinical presentation, disease course, or outcomes.MethodsWe report 15 kidney transplant recipients from the Columbia University kidney transplant program who required hospitalization for confirmed COVID-19, and describe their management, clinical course, and outcomes.ResultsPatients presented most often with a fever (87%) and/or cough (67%). Initial chest x-ray most commonly showed bilateral infiltrates, but 33% had no acute radiographic findings. Patients were managed with immunosuppression reduction and the addition of hydroxychloroquine and azithromycin. Although 27% of our patients needed mechanical ventilation, over half were discharged home by the end of follow-up.ConclusionsKidney transplant recipients with COVID-19 have presentations that are similar to that of the general population. Our current treatment protocol appears to be associated with favorable outcomes, but longer follow-up of a larger cohort of patients is needed.

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Immigration Brings New Pathology with No Standardized Treatment Protocol

Journal of the American Podiatric Medical Association ◽

10.7547/17-058 ◽

2018 ◽

Vol 108 (6) ◽

pp. 517-522

Author(s):

Tara L. Harrington ◽

Denten Eldredge ◽

Erica K. Benson

Keyword(s):

Opportunistic Infections ◽

Treatment Options ◽

Treatment Protocol ◽

Current Treatment ◽

Foot And Ankle ◽

Treatment Protocols ◽

Clinical Presentations ◽

Standardized Treatment ◽

Madura Foot ◽

Antimicrobial Interventions

Madura foot is an uncommon invasive soft-tissue infection that foot and ankle specialists encounter. We present two rare cases of Phialemonium and Phaeoacremonium fungi infections of the foot diagnosed in northern California to inform physicians on the presentation and current treatment options for this unique pathology. The two cases presented outline the clinical presentations, diagnostic data, and surgical and antimicrobial interventions. There is a concentration on the antimicrobial options depending on which of the over 20 species is encountered. The pertinent literature and supporting data are reviewed to create an outline for discussion of treatment protocols when faced with these emerging opportunistic infections.

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711 A Retrospective Review of Enoxaparin Dosing Practices in Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.297 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S187-S187

Author(s):

Asia N Quan ◽

Aisha Aden ◽

Claudia Islas ◽

Karen J Richey ◽

Kevin N Foster

Keyword(s):

Current Practice ◽

Retrospective Chart Review ◽

Medication Administration ◽

Inhalation Injury ◽

Low Flow ◽

Common Mechanism ◽

Burn Patients ◽

Dosing Regimen ◽

Actual Weight ◽

Starting Dose

Abstract Introduction Enoxaparin, a low molecular weight heparin, has been proven to safely and effectively prevent venous thromboembolism (VTE) in acutely ill patients. Burn patients may be particularly vulnerable to the occurrence of a VTE due to prolonged immobility, frequent operating room procedures, and low flow states. Treatment of acute VTE is associated with a direct medical cost of $12000-$15000 and subsequent complications increase costs to $18000 to $23000 per case. Current institutional protocol for initiation of enoxaparin an all burn adult patients is 40 mg administered subcutaneously every 12 hours. Anti-Xa levels are used to monitor anticoagulation prophylaxis, with 0.3–0.5 U/mL recognized as the prophylactic range. Doses are subsequently modified in 10 mg increments to achieve goal prophylaxis anti-Xa levles. The purpose of this study was to evaluate current practice (CP) and assess if the implementation of a published enoxaparin dosing algorithm could minimize delay in achieving anticoagulation prophylaxis. Methods A retrospective chart review was performed of 94 adult burn patients. The doses and time required to reach goal prophylaxis anti-Xa levels using current practice (CP) were compared to the predicted algorithm dose (AD). The number of dose adjustments and the number of days needed for adjustments for CP were documented. Charges related for laboratory determinations and medication administration were calculated. Results Of the 94 patients reviewed, the average age was 47 years, the majority were male (74%), mean actual weight 92 kilograms and mean TBSA 15.7%. The most common mechanism of injury was flash/flame (63%) with 18% suffering an inhalation injury. On average, using CP, it took 9.3 days to get to goal prophylaxis anti-Xa levels, with a mean of 2.86 anti-Xa lab tests needed and an average prophylactic dose of 55.5 mg. A total of 360 labs draws were performed and 74% were timed correctly. The CP average starting dose was lower than the AD 40 mg versus 45 mg (p < .0001). If the algorithm had been used the number of dosing adjustments would have been 25% less. The algorithm overestimated the starting dose in only 2.1% of the population. The average charges until goal was met for enoxaparin were $2,933 and $787 for anti-Xa levels. Conclusions This study demonstrates increased clinical efficacy and cost-effectiveness for an algorithm driven enoxaparin dosing regimen for burn patients. Prospective study with larger patient numbers is warranted. Applicability of Research to Practice Increased efficacy combined with decreased cost for an new enoxaparin dosing regimen.

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