Pleural Space Infections

Foley, Sean; Parrish, John S.

doi:10.3390/life13020376

Cited by 5 publications

(13 citation statements)

References 72 publications

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“…Regarding intra-pleural enzyme therapy, consensus has formed around the combination of the fibrinolytic tissue plasminogen activator (TPA) and viscosity-disrupting DNAse to reinitiate arrested pleural drainage. This combination has been shown to decrease referral to surgery but has had no effect on mortality [2 ▪▪ ] and increased the risk of bleeding [12]. This, coupled with poor evidence for the use of single agent TPA, DNAse, or streptokinase has led intra-pleural enzyme therapy to fall short of being part of routine empyema management.…”

Section: Treatmentmentioning

confidence: 99%

“…Mitigation of risk factors, early diagnosis, and prompt and effective treatment are the mainstay of prevention for empyema thoracis. Major risk factors are listed in Table 2[2 ▪▪ ,9,18].…”

Section: Preventionmentioning

confidence: 99%

“…Since antiquity, the mortality of empyema has been recognized and feared [1,2 ▪▪ ]; however, the microbiological cause has evolved over time. A systematic review by Hassan et al [3] identifies wide geographic variation in present-day bacterial cause with Staphylococcus aureus dominating as the leading causative organism globally.…”

Section: Aetiologymentioning

confidence: 99%

“…If indicated, cytology, acid/alcohol fast bacilli analysis, and fungal cultures can also be performed. Pleural biopsy has been shown to increase the yield for microbiological diagnosis [2 ▪▪ ]. Ample and varied microbiological samples should be taken at the earliest possibility to aid diagnosis and provide treatment options in a timely manner.…”

Section: Diagnosismentioning

confidence: 99%

“…Anaerobes can present a challenge to culture and so negative microbiological samples should not be treated as reassuring for anaerobic polymicrobial empyema. Aminoglycosides have no role in empyema treatment due to poor pleural penetration and probable inactivation by the acidity of the empyema [2 ▪▪ ].…”

Section: Treatmentmentioning

confidence: 99%

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Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Merchant,

Liu

2024

Current Opinion in Pulmonary Medicine

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Purpose of review The aim of this study was to review current key points in the aetiology, diagnosis, treatment, and prevention of empyema thoracis. Early postpandemic trends have seen an increasing global incidence and evolution in the aetiology of empyema. Due to varied aetiology and typically lengthy treatment, empyema will be disproportionately affected by the rising tide of antimicrobial resistance (AMR), thus warranting attention and further research. Recent findings Multiple novel biomarkers (e.g. IL-36γ) are under investigation to aid diagnosis, while oral health assessment tools are now available for prognosticating and risk-stratifying patients with thoracic empyema. There exists an ongoing lack of evidence-based guidance surrounding antibiotic treatment duration, surgical intervention indication, and prognostic scoring utility. Summary Understanding aetiologies in different global regions and settings is pivotal for guiding empirical treatment. Antimicrobial resistance will make thoracic empyema increasingly challenging to treat and should prompt increased awareness of prescribing practices. Novel biomarkers are under investigation which may speed up differentiation of pleural effusion types, allowing faster cohorting of patients. Although newly identified predictors of morbidity and mortality have been suggested to be beneficial for incorporation into clinical practice, further work is required to prognosticate, risk-stratify, and standardize treatment.

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Section: Treatmentmentioning

confidence: 99%

Section: Preventionmentioning

confidence: 99%

Section: Aetiologymentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Merchant,

Liu

2024

Current Opinion in Pulmonary Medicine

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Immunoassay with Novel Paired Antibodies for Detection of Lipoarabinomannan in the Pleural Fluid and Plasma of Patients with Tuberculous Pleurisy

Yan,

Wang,

Pang

et al. 2023

Microorganisms

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Tuberculous pleurisy (TP) is one of the most common forms of extrapulmonary tuberculosis, but its diagnosis is challenging. Lipoarabinomannan (LAM) antigen is a biomarker for Mycobacterium tuberculosis (Mtb) infection. LAM detection has potential as an auxiliary diagnostic method for TP. We have successfully generated five rabbit anti-LAM monoclonal antibodies (BJRbL01, BJRbL03, BJRbL20, BJRbL52, and BJRbL76). Here, anti-LAM antibodies were tested to detect LAM in the pleural fluid and plasma of patients with TP by sandwich enzyme-linked immunosorbent assays (ELISAs). The results revealed that all of the anti-LAM antibodies were successfully used as capture and detection antibodies in sandwich ELISAs. The BJRbL01/BJRbL01-Bio pair showed better performance than the other antibody pairs for detecting mycobacterial clinical isolates and had a limit of detection of 62.5 pg/mL for purified LAM. LAM levels were significantly higher in the pleural fluid and plasma of patients with TP than in those of patients with malignant pleural effusion or the plasma of non-TB, and LAM levels in the pleural fluid and plasma were positively correlated. Moreover, LAM levels in the pleural fluid sample were significantly higher in confirmed TP patients than in clinically diagnosed TP patients. Our studies provide novel LAM detection choices in the pleural fluid and plasma of TP patients and indicate that LAM detection assay has an auxiliary diagnostic value for TP, which may help to improve the diagnosis of TP.

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Analysis of Antibiotic Treatment and Microbiological Findings and Its Implication on Outcome in Patients with Parapneumonic Effusions

Petrusevska-Marinkovic

2024

Open Access Maced J Med Sci

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BACKGROUND: Parapneumonic effusion (PPE), as a complication of community-acquired pneumonia, sometimes progresses into complicated PPE (CPPE) and empyema, thus becoming a significant clinical problem. There is a lack of guidelines for antibiotic therapy and reports on local microbiological status and resistance of microorganisms. AIM: Тhe paper is focused on the analysis of antibiotic therapy and microbiological findings that are affecting patient outcomes and length of treatment. METHODS: We analyzed 94 patients, 50 with uncomplicated PPE (UCPPE) and 44 with CPPEs. RESULTS: More patients (59.57%) were male, average age 53.82 ± 17.5 years. Alcoholism was the most common comorbidity in patients with CPPE registered in 25% of patients. A positive pleural punctate culture was present in 31.82% of patients with CPPE. Peptostreptococcus was most often isolated in 28.57%. Blood culture was positive in 12.76% of patients. Most of the patients were treated with combined therapy that also covered anerobes (64.89%). Statistical differences existed in terms of days of hospital treatment with a longer hospital stay for patients with CPPE (p < 0.0001). The average time of hospital treatment in patients with UCPPE was 15 days, and in patients with CPPE, it was 21 days. CONCLUSION: As soon as a pleural infection is noted, patients should receive antibiotic therapy, which should be based on pleural fluid culture. Anerobic coverage is required. In this way, the development of CPPE and empyema will be prevented, and thus, mortality and long hospital stays will be reduced.

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Pleural Space Infections

Cited by 5 publications

References 72 publications

Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Thoracic empyema: aetiology, diagnosis, treatment, and prevention

Immunoassay with Novel Paired Antibodies for Detection of Lipoarabinomannan in the Pleural Fluid and Plasma of Patients with Tuberculous Pleurisy

Analysis of Antibiotic Treatment and Microbiological Findings and Its Implication on Outcome in Patients with Parapneumonic Effusions

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