Pleural infection in a New Zealand centre: high incidence in Pacific people and <scp>RAPID</scp> score as a prognostic tool

Wong, Donny; Yap, Elaine

doi:10.1111/imj.13087

Cited by 10 publications

(12 citation statements)

References 24 publications

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“…No fibrinolysis therapy use was reported and about half of all patients, who had a drain placed for an empyema needed surgical intervention. Wong and Yap reported on 108 patients with a CPE / empyema over a three-year period between Jan 2010 to December 2012 (7). Their number of empyema patients per year was similar to our number observed (36 vs 21); so was their yield of identifying an infective organism and their rates of needing surgical interventions was 13% (Table 3) 7.…”

supporting

confidence: 76%

“…This could be due to the aging population and increasing risk of malignancy. Based on reports from the United States and UK, a growing number of patients with pleural infection and malignancy can be expected (7). To improve efficiency and manage increasing demand for pleural investigations, a dedicated pleural service would be beneficial in Christchurch Hospital.…”

Section: Discussionmentioning

confidence: 99%

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Medical Chest Drain Insertion – Considerations for a Pleural Service

Liu¹,

Goh²,

Beckert

2020

Preprint

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Aim: To review local chest drain insertions, the indications, use of fibrinolytics, and the success rate of talc pleurodesis in a tertiary hospital in New Zealand. Methods: This is an observational study of all patients requiring chest drain insertion in the respiratory unit in Christchurch Hospital from January 2015 to December 2016. We analysed patient characteristics, type of drain inserted, and the nature of pleural fluid. We report the success of fibrinolytic therapy for empyema and pleurodesis for malignant pleural effusions. Results: A total of 486 chest drains were inserted for 333 patients, with a median age of 69 years. The majority of patients were male (60%) and 259 drains (53.3%) were inserted on the right. The main indications for chest drain insertion were malignant pleural effusions (50.5%), non-malignant pleural fluid (33.6%) and pneumothorax (17.7%). Most drains inserted were of small caliber; they were 12 French (Fr) (62.4%), central venous catheters to drain the pleural space (14.2%), and indwelling pleural catheters (10.9%). Talc slurry pleurodesis for malignant pleural effusions was used in 40 cases with a success rate of 75%. In the 41 cases of empyema and complicated parapneumonic effusions (CPE), 29 organisms were cultured. The majority of organisms identified were Streptococcus and Staphylococcus species. Fibrinolytics were used in 26 cases (52%) of empyema and CPE. Of the 22 patients who required surgical intervention, only two had prior fibrinolytic therapy for empyema / CPE. Conclusion: Small bore catheters were used in Christchurch in keeping with international guidelines. The success rate of talc slurry pleurodesis and fibrinolytic therapy was in keeping with international experience.

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supporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Medical Chest Drain Insertion – Considerations for a Pleural Service

Liu¹,

Goh²,

Beckert

2020

Preprint

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“…Treating pleural infection requires long hospital admission, averaging 14–17 days. 5 , 6 , 11 , 14 , 18 Together with the high comorbidity burden, the increasing use of expensive medications, and increasing rates of referral to surgery 15 translate into high health-care costs of managing pleural infection. 6 , 15 Despite this increasing economic burden, the last decade has seen the rate of fatal pleural infection double, 12 with a similar rise in 30-day mortality rates.…”

Section: Epidemiologymentioning

confidence: 99%

Recent Insights into the Management of Pleural Infection

Hassan

Patel

Sadaka

et al. 2021

IJGM

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Pleural infection in adults has considerable morbidity and continues to be a lifethreatening condition. The term "pleural infection" encompasses complicated parapneumonic effusions and primary pleural infections, and includes but is not limited to empyema, which refers to collection of pus in the pleural cavity. The incidence of pleural infection in adults has been continuously increasing over the past two decades, particularly in older adults, and most of such patients have comorbidities. Management of pleural infection requires prolonged duration of hospitalization (average 14 days). There are recognized differences in microbial etiology of pleural infection depending on whether the infection was acquired in the community or in a health-care setting. Anaerobic bacteria are acknowledged as a major cause of pleural infection, and thus anaerobic coverage in antibiotic regimens for pleural infection is mandatory. The key components of managing pleural infection are appropriate antimicrobial therapy and chest-tube drainage. In patients who fail medical therapy by manifesting persistent sepsis despite standard measures, surgical intervention to clear the infected space or intrapleural fibrinolytic therapy (in poor surgical candidates) are recommended. Recent studies have explored the role of early intrapleural fibrinolytics or first-line surgery, but due to considerable costs of such interventions and the lack of convincing evidence of improved outcomes with early use, early intervention cannot be recommended, and further evidence is awaited from ongoing studies. Other areas of research include the role of routine molecular testing of infected pleural fluid in improving the rate of identification of causative organisms. Other research topics include the benefit of such interventions as medical thoracoscopy, high-volume pleural irrigation with saline/antiseptic solution, and repeated thoracentesis (as opposed to chest-tube drainage) in reducing morbidity and improving outcomes of pleural infection. This review summarizes current knowledge and practice in managing pleural infection and future research directions.

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“…Community-acquired pleural empyema is a disease of significant morbidity and mortality, with 30-day mortality rates of 9-13% previously reported [1][2][3][4][5]. Risk factors include diabetes mellitus, immunosuppression, intravenous drug use, alcohol misuse and gastro-oesophageal reflux [6].…”

Section: Introductionmentioning

confidence: 99%

16S rRNA is a valuable tool in finding bacterial aetiology of community-acquired pleural empyema–a population-based observational study in South Sweden

Ljungquist

Bläckberg

Hjertman

2021

Infectious Diseases

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Background: The incidence of community-acquired pleural empyema is increasing. Knowledge of the bacterial aetiology is important in order to base recommendations on empirical antimicrobial treatment. The primary aim of the present study was to describe the bacterial aetiology of adult patients with culture proven and/or 16S rRNA-positive community-acquired pleural infection. Methods: We performed a retrospective, population-based observational cohort study in Skåne County, south of Sweden. We included all patients with pleural samples obtained between 1st of January 2011 to 31st of December 2017 in Skåne, south of Sweden, with a positive culture and/or 16S rRNA result. Exclusion criteria were patients with culture-negative and/ or 16S rRNA-negative pleural samples, age < 18 years, pleural empyema caused by trauma or iatrogenesis, pleural infection caused by tuberculosis or fungi, simultaneous lung-or abscess of the abdomen and bacterial species considered to be contaminants. Results: A total of 291 patients were included in the study, of which 63% were men and the median age was 69 years. The dominating bacterial aetiology was viridans streptococci (36%), followed by Streptococcus pneumoniae (14%) and anaerobic bacteria (12%). 16S rRNA added information of bacterial aetiology in addition to standard culturing methods in 63% of the patients. Conclusion:We found that the aetiology of adult patients with culture proven and/or 16S rRNA-positive communityacquired pleural empyema is dominated by viridans streptococci, S. pneumoniae and anaerobic bacteria. Our study shows that 16S rRNA is a valuable tool in finding the bacterial aetiology of community-acquired pleural empyema.

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Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool

Abstract: The over-representation of Pacific people with pleural infection is not fully explained by socioeconomic deprivation, highlighting other factors at play, such as genetic susceptibility. The RAPID score was of clinical utility in predicting mortality in our population.

Cited by 10 publications

References 24 publications

Medical Chest Drain Insertion – Considerations for a Pleural Service

Medical Chest Drain Insertion – Considerations for a Pleural Service

Recent Insights into the Management of Pleural Infection

16S rRNA is a valuable tool in finding bacterial aetiology of community-acquired pleural empyema–a population-based observational study in South Sweden

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