Pleural infection: past, present, and future directions.
Author(s): Corcoran JP(1), Wrightson JM(2), Belcher E(3), DeCamp MM(4), Feller-Kopman D(5),
Rahman NM(6).
Affiliation(s): Author information:
(1)Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust,
Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital,
Oxford, UK. (2)Oxford Centre for Respiratory Medicine, Oxford University
Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit,
Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre,
University of Oxford, Oxford, UK. (3)Department of Cardiothoracic Surgery, Oxford
University Hospitals NHS Trust, Oxford, UK. (4)Division of Thoracic Surgery,
Northwestern Memorial Hospital, Northwestern University Feinberg School of
Medicine, Chicago, IL, USA. (5)Division of Pulmonary and Critical Care Medicine,
Johns Hopkins Hospital, Baltimore, MD, USA. (6)Oxford Centre for Respiratory
Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford
Respiratory Trials Unit, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical
Research Centre, University of Oxford, Oxford, UK. Electronic address:
najib.rahman@ndm.ox.ac.uk.
Publication date & source: 2015, Lancet Respir Med. , 3(7):563-77
Pleural space infections are increasing in incidence and continue to have high
associated morbidity, mortality, and need for invasive treatments such as
thoracic surgery. The mechanisms of progression from a non-infected,
pneumonia-related effusion to a confirmed pleural infection have been well
described in the scientific literature, but the route by which pathogenic
organisms access the pleural space is poorly understood. Data suggests that not
all pleural infections can be related to lung parenchymal infection. Studies
examining the microbiological profile of pleural infection inform antibiotic
choice and can help to delineate the source and pathogenesis of infection. The
development of radiological methods and use of clinical indices to predict which
patients with pleural infection will have a poor outcome, as well as inform
patient selection for more invasive treatments, is particularly important.
Randomised clinical trial and case series data have shown that the combination of
an intrapleural tissue plasminogen activator and deoxyribonuclease therapy can
potentially improve outcomes, but the use of this treatment as compared with
surgical options has not been precisely defined, particularly in terms of when
and in which patients it should be used.
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