Management of pleural space infections: A population-based analysis

Farjah, Farhood; Symons, Rebecca; Krishnadasan, Bahirathan; Wood, Douglas E.; Flum, David R.

doi:10.1016/j.jtcvs.2006.09.038

Cited by 197 publications

(221 citation statements)

References 11 publications

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“…Infectious pleural effusion status and treatment progress Epidemiology Globally (13)(14)(15), pleural cavity infection occurrence rate has been constantly increasing for each age group with an unknown cause (1,16). For example, from 1996 to 2008, admission rate has been increased two times for the patients suffering from empyema in America (3.04-5.98/100,000) (1).…”

Section: Review Articlementioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication.According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future.

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Section: Review Articlementioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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“…2,3,19 Following the introduction of the 7-valent pneumococcal conjugate vaccine, there is evidence that the non-vaccine serotype 1 is causing increasing cases of pleural infection and other invasive pneumococcal disease. Diabetes, the immunosuppressed state, alcohol misuse and intravenous (iv) drug abuse have been shown to be risk factors for pleural infection in adults.…”

Section: Risk Factorsmentioning

confidence: 99%

“…1 The median length of hospital stay is 12-15 days but 25% of these patients are inpatients for more than one month. [2][3][4][5] The infection occurs most commonly in association with pneumonia. Up to 57% of patients with pneumonia develop a parapneumonic pleural effusion, 6 varying in size from a very small effusion, not visible on the chest x-ray, to a large effusion causing significant ventilatory compromise.…”

mentioning

confidence: 99%

Pleural infection

Wrightson

Maskell²

2012

Clinical Medicine

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“…1,2 Despite advances in medical management, mortality from empyema remains high (10% to 20%). 3,4 Approximately 15% of patients fail to respond to standard treatments, ultimately requiring surgery. 2,3 Inadequate intrapleural drug concentrations resulting from poor penetration of systemic antibiotics into the pleural cavity is a major cause of treatment failure in empyema.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Approximately 15% of patients fail to respond to standard treatments, ultimately requiring surgery. 2,3 Inadequate intrapleural drug concentrations resulting from poor penetration of systemic antibiotics into the pleural cavity is a major cause of treatment failure in empyema. Although antibiotics are generally believed to be present in pleural fluid at levels that are comparable to those attained in serum after intravenous administration, clinically sound evidence remains limited.…”

Section: Introductionmentioning

confidence: 99%

Sustained release of bactericidal concentrations of penicillin in the pleural space via an antibiotic-eluting pigtail catheter coated with electrospun nanofibers: results from in vivo and in vitro studies

Chao¹,

Lee²,

Liu³

et al. 2015

IJN

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Background Inadequate intrapleural drug concentrations caused by poor penetration of systemic antibiotics into the pleural cavity is a major cause of treatment failure in empyema. Herein, we describe a novel antibiotic-eluting pigtail catheter coated with electrospun nanofibers used for the sustained release of bactericidal concentrations of penicillin in the pleural space. Methods Electrospun nanofibers prepared using polylactide-polyglycolide copolymer and penicillin G sodium dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol were used to coat the surface of an Fr6 pigtail catheter. The in vitro patterns of drug release were tested by placing the catheter in phosphate-buffered saline. In vivo studies were performed using rabbits treated with penicillin either intrapleurally (Group 1, 20 mg delivered through the catheter) or systemically (Group 2, intramuscular injection, 10 mg/kg). Penicillin concentrations in the serum and pleural fluid were then measured and compared. Results In vitro studies revealed a burst release of penicillin (10% of the total dose) occurring in the first 24 hours, followed by a sustained release in the subsequent 30 days. Intrapleural drug levels were significantly higher in Group 1 than in Group 2 ( P <0.001). In the former, penicillin concentrations remained above the minimum inhibitory concentration breakpoint throughout the entire study period. In contrast, serum penicillin levels were significantly higher in Group 2 than in Group 1 ( P <0.001). Notably, all Group 2 rabbits showed signs of systemic toxicity (paralytic ileus and weight loss). Conclusion We conclude that our antibiotic-eluting catheter may serve as a novel therapeutic option to treat empyema.

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Management of pleural space infections: A population-based analysis

Cited by 197 publications

References 11 publications

Infectious pleural effusion status and treatment progress

Infectious pleural effusion status and treatment progress

Pleural infection

Sustained release of bactericidal concentrations of penicillin in the pleural space via an antibiotic-eluting pigtail catheter coated with electrospun nanofibers: results from in vivo and in vitro studies

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