Trends in the Incidence, Etiology, Treatment, and Outcomes of Pleural Infections in Adults Over a Decade in a Finnish University Hospital

Lehtomäki, Antti; Nevalainen, Riikka; Ukkonen, Mika; Nieminen, J.; Laurikka, Jari; Khan, Jahangir

doi:10.1177/1457496919832146

Cited by 19 publications

(30 citation statements)

References 25 publications

(34 reference statements)

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“…The incidence of pleural infection nearly doubled from the first to the second decade of the 21st century. 11,12,14 In Europe, the US, Canada, and Australia, 5,6,8,13,14,16 the average age of patients diagnosed with pleural infection is 58-63 years. However, a recent systematic review pointed out a discrepancy in the age bracket of adult patients with pleural infection between high-income and low(er)-income countries, where patients in the latter group tended to be 15 years younger on average.…”

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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Section: Epidemiologymentioning

confidence: 99%

Recent Insights into the Management of Pleural Infection

Hassan

Patel

Sadaka

et al. 2021

IJGM

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“…Reliable demographic or clinical features that indicate empyema associated with CAP have not emerged. 22 Pleural infection is roughly twice as prevalent in men, [11][12][13]15,[23][24][25] in patients with comorbidities (particularly diabetes mellitus, 23,24,[26][27][28][29][30][31] hypoalbuminemia, 7,8 and alcoholism). 7,8,26,32,33 However, the only independent variable associated with empyema (n ¼ 128) among 1,080 patients with invasive pneumococcal infection was the pneumococcal serotype (not any clinical or demographic features).…”

Section: General Principles Of Management Timely Identification Of Plmentioning

confidence: 99%

“…The crude and/or age-adjusted incidence of adult pleural infection is consistently rising in diverse cohorts and health systems (e.g., in Canada, 10,11 Denmark, 12 Finland, 13 and the United States). 14,15 The largest incidence ratio increase is in the elderly.…”

mentioning

confidence: 99%

Medical and Surgical Management of Empyema

Godfrey

Bramley

Detterbeck

2019

Semin Respir Crit Care Med

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Infection of the pleural space is an ancient and common clinical problem, the incidence which is on the rise. Advances in therapy now present clinicians of varying disciplines with an array of therapeutic options ranging from thoracentesis and chest tube drainage (with or without intrapleural fibrinolytic therapies) to video-assisted thoracic surgery (VATS) or thoracotomy. A framework is provided to guide decision making, which involves weighing multiple factors (clinical history and presentation, imaging characteristics, comorbidities); multidisciplinary collaboration and active management are needed as the clinical course over a few days determines subsequent refinement. The initial choice of antibiotics depends on whether the empyema is community-acquired or nosocomial, and clinicians must recognize that culture results often do not reflect the full disease process. Antibiotics alone are rarely successful and can be justified only in specific circumstances. Early drainage with or without intrapleural fibrinolytics is usually required. This is successful in most patients; however, when surgical decortication is needed, clear benefit and low physiologic impact are more likely with early intervention, expeditious escalation of interventions, and care at a center experienced with VATS.

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Section: Introductionmentioning

confidence: 99%

“…Infections of the pleura are increasingly common and a substantial burden for health care as the disease often necessitates long hospitalization, lengthy antimicrobial regimens, pleural drainage, and even surgery (1–4). Most cases are related to pulmonary infections, but malignancies and other causes play a role as well (1). The overall long-term survival of these patients is impacted, and the authors have previously reported that the rate of cancer-related deaths was approximately twofold in these patients when compared with that of age- and gender-matched controls (5, 6).…”

Section: Introductionmentioning

confidence: 99%

The Occurrence of Lung Cancer and Non-Pulmonary Malignancies After Pleural Infections

et al. 2020

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Background and Aims: Patients who develop infections of the pleura have several risk factors for malignancies, particularly lung cancer, and the infections might even be caused by undiagnosed intra-thoracic neoplasms. The aim of the study was to compare the occurrence of lung cancer and other malignancies between patients treated for pleural infections and controls during long-term follow-up. Materials and Methods: All consecutive patients treated for pleural infections between January 2000 and June 2016 at the Tampere University Hospital were included. Ten matched controls and data regarding later cancer diagnoses were requested from national registries. The cancer types and rates, the diagnostic delays, as well as survival were compared between patients and controls. Results: The material comprised 506 patients and 5022 controls (78% was male and median age was 60 years in both groups) with a median follow-up time of 69 months. In total, 74% of pleural infections were related to pneumonia. The occurrence of lung cancer during follow-up was 3.0% in all patients, 2.2% in pneumonia-related cases, and 0.6% in controls, p < 0.001 when compared with controls. The overall rate of non-pulmonary malignancies did not differ. Lung cancer was diagnosed within 3 months in 73% of patients versus in 6.9% of controls, p < 0.001. The survival in patients with later lung cancers or other malignancies was inferior to that of controls with similar neoplasms. Conclusion: The rate of lung cancer diagnoses was significantly increased in patients treated for pleural infections when compared with matched controls and the prognosis of patients with subsequent malignancies was impacted.

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Trends in the Incidence, Etiology, Treatment, and Outcomes of Pleural Infections in Adults Over a Decade in a Finnish University Hospital

Cited by 19 publications

References 25 publications

Recent Insights into the Management of Pleural Infection

Recent Insights into the Management of Pleural Infection

Medical and Surgical Management of Empyema

The Occurrence of Lung Cancer and Non-Pulmonary Malignancies After Pleural Infections

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