TY - JOUR
T1 - Clinical outcomes of indwelling pleural catheter-related pleural infections
T2 - An international multicenter study
AU - Fysh, Edward T.H.
AU - Tremblay, Alain
AU - Feller-Kopman, David
AU - Mishra, Eleanor K.
AU - Slade, Mark
AU - Garske, Luke
AU - Clive, Amelia O.
AU - Lamb, Carla
AU - Boshuizen, Rogier
AU - Ng, Benjamin J.
AU - Rosenstengel, Andrew W.
AU - Yarmus, Lonny
AU - Rahman, Najib M.
AU - Maskell, Nick A.
AU - Gary Lee, Y. C.
N1 - Funding Information:
Funding/Support: Dr Fysh receives scholarships from the NHMRC and the Lung Institute of Western Australia and a research project grant from the New South Wales Dust Disease Board. Prof Lee receives research funding from the National Health and Medical Research Council (NHMRC), New South Wales Dust Disease Board, the Sir Charles Gairdner Research Advisory Committee, and the Cancer Council of Western Australia.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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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U2 - 10.1378/chest.12-3103
DO - 10.1378/chest.12-3103
M3 - Article
C2 - 23828305
AN - SCOPUS:84887496608
SN - 0012-3692
VL - 144
SP - 1597
EP - 1602
JO - CHEST
JF - CHEST
IS - 5
ER -