Pleural infection: past, present, and future directions

Corcoran, John; Wrightson, John; Belcher, Elizabeth; DeCamp, Malcolm M.; Feller‐Kopman, David; Rahman, Najib M.

doi:10.1016/s2213-2600(15)00185-x

Cited by 88 publications

(85 citation statements)

References 121 publications

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“…Pleural infections are a significant problem worldwide and are an important cause for the need to perform a decortication 26–28. Pneumonia often precedes pleural infections; however, the pathophysiology of this process is not completely understood and the organisms isolated from pleural samples differ considerably from usual pneumonia pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumonia often precedes pleural infections; however, the pathophysiology of this process is not completely understood and the organisms isolated from pleural samples differ considerably from usual pneumonia pathogens. Administration of antibiotics prior to sampling, low diagnostic yield, and difficulty isolating and identifying fastidious organisms likely contribute to this; however, transpleural spread of bacteria may be only one of several mechanisms for developing pleural infections 28–32…”

Section: Discussionmentioning

confidence: 99%

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Perioperative implications of thoracic decortications: a retrospective cohort study

Gorman

Funk

Srinathan

et al. 2017

Can J Anesth/J Can Anesth

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PurposeAn increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes.MethodsData for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive.ResultsOne hundred ninety-two patients underwent a decortication. The most frequent disease processes resulting in a decortication were pneumonia (60%), trauma (13%), malignancy (8%), and procedural complications (5%). The number of decortications due to complications of pneumonia rose at the greatest rate, from three cases in 2007 to 29 cases in 2014. Performing a decortication for an infectious vs a non-infectious etiology was associated with a higher rate of the composite postoperative outcome of myocardial infarction, acute kidney injury, need of vasopressors for > 12 hr, and mechanical ventilation for > 48 hr (44.4% vs 24.2%, respectively; relative risk, 1.83; 95% confidence interval, 1.1 to 2.9; P = 0.01).ConclusionThere has been a ninefold increase in decortications over an eight-year period. Potential causes include an increase in the incidence of pneumonia, increased organism virulence, host changes, and changes in practice patterns. Patients undergoing decortication for infectious causes had an increased risk for adverse perioperative outcomes. Anesthesiologists need to be aware of the high perioperative morbidity of these patients and the potential need for postoperative admission to an intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative implications of thoracic decortications: a retrospective cohort study

Gorman

Funk

Srinathan

et al. 2017

Can J Anesth/J Can Anesth

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“…These findings provide important insights into the role of neutrophils in CPPE pathogenesis. During the acute phase of infectious pleural effusions, neutrophils are the first leukocytes to be recruited to the inflamed tissues, leading to elevated neutrophil counts in pleural effusions 28 . In our study, the percentage of neutrophils in total nucleated cells was significantly higher in CPPEs (84.8 ± 2.7%) than in UPPEs (68.1 ± 3.1%) (Data not shown).…”

Section: Discussionmentioning

confidence: 99%

Proteome profiling reveals novel biomarkers to identify complicated parapneumonic effusions

Chen

et al. 2017

Sci Rep

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Patients with pneumonia and parapneumonic effusion (PPE) have elevated mortality and a poor prognosis. The aim of this study was to discover novel biomarkers to help distinguish between uncomplicated PPE (UPPE) and complicated PPE (CPPE). Using an iTRAQ-based quantitative proteomics, we identified 766 proteins in pleural effusions from PPE patients. In total, 45 of these proteins were quantified as upregulated proteins in CPPE. Four novel upregulated candidates (BPI, NGAL, AZU1, and calprotectin) were selected and further verified using enzyme-linked immunosorbent assays (ELISAs) on 220 patients with pleural effusions due to different causes. The pleural fluid levels of BPI, NGAL, AZU1, and calprotectin were significantly elevated in patients with CPPE. Among these four biomarkers, BPI had the best diagnostic value for CPPE, with an AUC value of 0.966, a sensitivity of 97%, and a specificity of 91.4%. A logistic regression analysis demonstrated a strong association between BPI levels > 10 ng/ml and CPPE (odds ratio = 341.3). Furthermore, the combination of pleural fluid BPI levels with LDH levels improved the sensitivity and specificity to 100% and 91.4%, respectively. Thus, our findings provided a comprehensive effusion proteome data set for PPE biomarker discovery and revealed novel biomarkers for the diagnosis of CPPE.

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“…The incidence of pleural infection has increased over the past two decades, with a variety of reasons proposed for this changing clinical picture (2). What has not changed is the morbidity and mortality associated with this condition in adults.…”

mentioning

confidence: 99%

“…Much of this work has been focused on improving the efficacy of tube thoracostomy and clearance of infected material from the pleural space, especially considering that drainage becomes increasingly difficult over time as septations and loculations develop (2). Combination intrapleural therapy with tissue plasminogen activator and DNase may have a positive influence on relevant clinical outcomes (5,6), but it is expensive and requires further validation in large-scale clinical trials before routine use in all patients.…”

mentioning

confidence: 99%

Pleural Diseases: Saline Irrigation in Pleural Infection, Epidemiology of Pneumothorax, and Bevacizumab in Mesothelioma

Corcoran

Hallifax

Psallidas

et al. 2017

Am J Respir Crit Care Med

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Pleural infection: past, present, and future directions

Cited by 88 publications

References 121 publications

Perioperative implications of thoracic decortications: a retrospective cohort study

Perioperative implications of thoracic decortications: a retrospective cohort study

Proteome profiling reveals novel biomarkers to identify complicated parapneumonic effusions

Pleural Diseases: Saline Irrigation in Pleural Infection, Epidemiology of Pneumothorax, and Bevacizumab in Mesothelioma

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