Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy. A Multicenter Study

Wilshire, Candice L.; Chang, Shu Ching; Gilbert, Christopher R.; Akulian, Jason; Alsarraj, Mohammed K.; Asciak, Rachelle; Bevill, Benjamin; Davidson, Kevin; Delgado, Ashley; Grosu, Horiana B.; Herth, Felix J.F.; Lee, Hans J.; Lewis, Justin; Maldonado, Fabien; Ost, David; Pastis, Nicholas J.; Rahman, Najib M.; Reddy, Chakravarthy; Roller, Lance; Sánchez, Trinidad; Shojaee, Samira; Steer, Henry; Thiboutot, Jeffrey; Wahidi, Momen M.; Wright, Amber N.; Yarmus, Lonny; Gorden, Jed A.

doi:10.1513/annalsats.202007-886oc

Cited by 16 publications

(11 citation statements)

References 37 publications

(69 reference statements)

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“…In addition, the reported median time was 41 (interquartile range 19–87) days, and neither antineoplastic therapy nor immunocompromised state increased the risk of IPC‐related infection according to a multicenter study of 1408 IPCs among 1318 patients with MPE. 59 These investigators’ conclusions were consistent with those of Mekhaiel et al 60 …”

Section: Discussionsupporting

confidence: 81%

“…In addition, the reported median time was 41 (interquartile range 19-87) days, and neither antineoplastic therapy nor immunocompromised state increased the risk of IPC-related infection according to a multicenter study of 1408 IPCs among 1318 patients with MPE. 59 These investigators' conclusions were consistent with those of Mekhaiel et al 60 Methods to prevent and effectively treat postoperative infection, in addition to primary disease management, are high priorities. Zhao et al studied 128 patients with MPE under focused preventive interventions, including maintaining an aseptic field throughout the surgical process, educating patients about normative IPC use, monitoring wound conditions, and regularly changing wound dressing and drainage bags; these significantly reduced IPC-related infection incidence from 13% to 5%.…”

Section: F I G U R Esupporting

confidence: 64%

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Incidence of complications from indwelling pleural catheter for pleural effusion: A meta‐analysis

Wang

Zhang

Wan

et al. 2022

Clinical Translational Sci

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Indwelling pleural catheter (IPC) is widely used in patients with pleural effusion (PE). This meta‐analysis aimed to comprehensively summarize the clinical complication from IPC. We searched four large electronic databases (PubMed, EMBASE, MEDLINE, and Cochrane Library) for potentially relevant studies and assessed the included studies’ quality using the methodological index for nonrandomized studies’ criteria. Extracted data were used to pool rates, and to conduct subgroup and meta–regression analyses. Forty‐one studies involving a cumulative 4983 patients with 5650 IPCs were included in this meta‐analysis. The overall incidence of IPC complications was 20.3% (95% confidence interval [CI]: 15.0–26.3). The top four complications were: overall infection incidence 5.7% (95% CI: 0.7–2.4); overall catheter abnormality incidence 4.4% (95% CI: 2.8–6.3); pain incidence 1.2% (95% CI: 0.4–2.4); and overall loculation incidence 0.9% (95% CI: 0.1–2.1). Subgroup and meta‐regression analyses for overall complications and infections by country, PE site, and PE type demonstrated these factors did not contribute significantly to heterogeneity. Further subgroup analyses for infection of benign PE showed that the overall infection incidence (12.6% [95% CI: 8.1–17.8] vs 0.7% [95% CI: 0.0–4.5]) and empyema incidence (9.1% [95% CI: 5.3–13.8] vs 0.0% [95% CI: 0.0–2.3]) of patients with liver‐related PE were significantly higher than that of patients with heart‐related PE. Our meta‐analysis showed reliable pooled incidences of IPC‐related complications, with infection being the most common. These results serve to remind clinicians about the incidence of IPC‐related complications and emphasize the importance of taking corresponding preventive and therapeutic steps.

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Section: Discussionsupporting

confidence: 81%

Section: F I G U R Esupporting

confidence: 64%

Incidence of complications from indwelling pleural catheter for pleural effusion: A meta‐analysis

Wang

Zhang

Wan

et al. 2022

Clinical Translational Sci

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“…In a large multicentre retrospective review of 1021 patients treated with IPC, pleural space infections specifically developed in 50 (4.9%) patients with an overall mortality risk of 0.3% [109], significantly lower than standard pleural infection. In another large multicentre series (n=1318), WILSHIRE et al [110] recently found a similar infection rate (6-7%) but importantly also showed that the risk of IPC-related infection did not appear to be increased by antineoplastic therapy use or an immunocompromised state. In multivariable competing risk analyses they found longer IPC in situ duration to be associated with a higher risk of infection [110].…”

Section: Indwelling Pleural Catheters and Pleural Infectionmentioning

confidence: 75%

“…In another large multicentre series (n=1318), WILSHIRE et al [110] recently found a similar infection rate (6-7%) but importantly also showed that the risk of IPC-related infection did not appear to be increased by antineoplastic therapy use or an immunocompromised state. In multivariable competing risk analyses they found longer IPC in situ duration to be associated with a higher risk of infection [110].…”

Section: Indwelling Pleural Catheters and Pleural Infectionmentioning

confidence: 75%

“…IPC-related infections generally tend to occur around 6 weeks post-insertion [109,110], which goes against them being directly procedure related; however, studies investigating the mechanisms leading to pleural space infections in this group are lacking [111]. They are most frequently reported in association with S. aureus organisms followed by Pseudomonas aeruginosa; however, to date, there are no studies specifically evaluating the bacteriology and significance of bacterial colonisation in this cohort [8].…”

Section: Indwelling Pleural Catheters and Pleural Infectionmentioning

confidence: 97%

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ERS/ESTS statement on the management of pleural infection in adults

et al. 2022

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Pleural infection is a common condition encountered by respiratory physicians and thoracic surgeons alike. The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) established a multidisciplinary collaboration of clinicians with expertise in managing pleural infection with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified including the epidemiology of pleural infection, the optimal antibiotic strategy, diagnostic parameters for chest tube drainage, the status of intrapleural therapies, the role of surgery and the current place of outcome prediction in management.The literature revealed that recently updated epidemiological data continue to show an overall upwards trend in incidence, but there is an urgent need for a more comprehensive characterisation of burden of pleural infection in specific populations such as immunocompromised hosts. There is a sparsity of regular analyses and documentation of microbiological patterns at a local level to inform geographical variation and ongoing research efforts are needed to improve antibiotic stewardship. The evidence remains in favour of a small-bore chest tube optimally placed under image guidance as an appropriate initial intervention for most cases of pleural infection. With a growing body of data suggesting delays to treatment are key contributors to poor outcomes, this suggests that earlier consideration of combination intrapleural enzyme therapy (IET) with concurrent surgical consultation should remain a priority. Since publication of the MIST-2 study, there has been considerable data supporting safety and efficacy of IET, but further studies are needed to optimise dosing using individualised biomarkers of treatment failure. Pending further prospective evaluation, the MIST-2 regimen remains the most evidence based. Several studies have externally validated the RAPID score, but it requires incorporating into prospective intervention studies prior to adopting into clinical practice.

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Multimodal Approaches Toward Management of Malignant Pleural Effusion: Establishing Treatment Goals is Paramount

Dipper

Welch

Maskell

2022

Archivos de Bronconeumología

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Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy. A Multicenter Study

Cited by 16 publications

References 37 publications

Incidence of complications from indwelling pleural catheter for pleural effusion: A meta‐analysis

Incidence of complications from indwelling pleural catheter for pleural effusion: A meta‐analysis

ERS/ESTS statement on the management of pleural infection in adults

Multimodal Approaches Toward Management of Malignant Pleural Effusion: Establishing Treatment Goals is Paramount

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