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Chest. 2013 Nov;144(5):1597-1602. doi: 10.1378/chest.12-3103.

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

Author information

1
Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; Centre for Asthma, Allergy, and Respiratory Research, and the School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
2
Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
3
Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
4
Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
5
Department of Thoracic Oncology, Papworth Hospital, Cambridge, England.
6
Princess Alexandra Hospital, Brisbane, QLD, Australia.
7
Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England.
8
Lahey Clinic, Burlington, MA.
9
Netherlands Cancer Institute, Amsterdam, The Netherlands.
10
Nepean Hospital Lung Cancer Multidisciplinary Group, Sydney, NSW, Australia.
11
Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
12
Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; Centre for Asthma, Allergy, and Respiratory Research, and the School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia. Electronic address: gary.lee@uwa.edu.au.

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.

PMID:
23828305
DOI:
10.1378/chest.12-3103
[Indexed for MEDLINE]

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