Clinical outcomes of indwelling pleural catheter-related pleural infections: An international multicenter study

Fysh, E.T.H., Tremblay, A., Feller-Kopman, D., Mishra, E.K., Slade, M., Garske, L., Clive, A.O., Lamb, C., Boshuizen, R., Ng, B.J., Rosenstengel, A.W., Yarmus, L., Rahman, N.M., Maskell, N.A. and Gary Lee, Y.C. (2013) Clinical outcomes of indwelling pleural catheter-related pleural infections: An international multicenter study. Chest, 144 5: 1597-1602. doi:10.1378/chest.12-3103

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Author Fysh, E.T.H.
Tremblay, A.
Feller-Kopman, D.
Mishra, E.K.
Slade, M.
Garske, L.
Clive, A.O.
Lamb, C.
Boshuizen, R.
Ng, B.J.
Rosenstengel, A.W.
Yarmus, L.
Rahman, N.M.
Maskell, N.A.
Gary Lee, Y.C.
Title Clinical outcomes of indwelling pleural catheter-related pleural infections: An international multicenter study
Journal name Chest   Check publisher's open access policy
ISSN 0012-3692
1931-3543
Publication date 2013-01-01
Sub-type Article (original research)
DOI 10.1378/chest.12-3103
Volume 144
Issue 5
Start page 1597
End page 1602
Total pages 6
Place of publication Northbrook, IL, U.S.A.
Publisher American College of Chest Physicians
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
2706 Critical Care and Intensive Care Medicine
2705 Cardiology and Cardiovascular Medicine
Abstract Background: Indwelling pleural catheters (IPCs) offer effective control of malignant pleural effusions (MPEs). IPC-related infection is uncommon but remains a major concern. Individual IPC centers see few infections, and previous reports lack sufficient numbers and detail. This study combined the experience of 11 centers from North America, Europe, and Australia to describe the incidence, microbiology, management, and clinical outcomes of IPC-related pleural infection. Methods: This was a multicenter retrospective review of 1,021 patients with IPCs. All had confirmed MPE. Results: Only 50 patients (4.9%) developed an IPC-related pleural infection; most (94%) were successfully controlled with antibiotics (62% IV). One death (2%) directly resulted from the infection, whereas two patients (4%) had ongoing infectious symptoms when they died of cancer progression. Staphylococcus aureus was the causative organism in 48% of cases. Infections from gram-negative organisms were associated with an increased need for continuous antibiotics or death (60% vs 15% in gram-positive and 25% mixed infections, P =.02). The infections in the majority (54%) of cases were managed successfully without removing the IPC. Postinfection pleurodesis developed in 31 patients (62%), especially those infected with staphylococci (79% vs 45% with nonstaphylococcal infections, P =.04). Conclusions: The incidence of IPC-related pleural infection was low. The overall mortality risk from pleural infection in patients treated with IPC was only 0.29%. Antibiotics should cover S aureus and gram-negative organisms until microbiology is confirmed. Postinfection pleurodesis is common and often allows removal of IPC. Heterogeneity in management is common, and future studies to define the optimal treatment strategies are needed.
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Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Created: Thu, 10 Apr 2014, 23:59:15 EST by Matthew Lamb on behalf of School of Medicine