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Respirology (Carlton, Vic.) May 2011The incidence of pleural infection continues to rise worldwide. Identifying the causative organism(s) is important to guide antimicrobial therapy. The bacteriology of... (Review)
Review
The incidence of pleural infection continues to rise worldwide. Identifying the causative organism(s) is important to guide antimicrobial therapy. The bacteriology of pleural infection is complex and has changed over time. Recent data suggest that the bacterial causes of empyema are significantly different between adult and paediatric patients, between community-acquired and nosocomial empyemas and can vary among geographical regions of the world. Since the introduction of pneumococcal vaccines, a change has been observed in the distribution of the serotypes of Streptococcus pneumoniae in empyema. These observations have implications on therapy and vaccine strategies. Clinicians need to be aware of the local bacteriology of empyema in order to guide antibiotic treatment.
Topics: Bacterial Infections; Community-Acquired Infections; Cross Infection; Empyema, Pleural; Humans; Pneumococcal Infections; Pneumococcal Vaccines; Serotyping
PubMed: 21382129
DOI: 10.1111/j.1440-1843.2011.01964.x -
BMJ Open Mar 2022Pleural empyema is a frequent disease with a high morbidity and mortality. Current standard treatment includes antibiotics and thoracic ultrasound (TUS)-guided pigtail...
Intrapleural fibrinolysis and DNase versus video-assisted thoracic surgery (VATS) for the treatment of pleural empyema (FIVERVATS): protocol for a randomised, controlled trial - surgery as first-line treatment.
INTRODUCTION
Pleural empyema is a frequent disease with a high morbidity and mortality. Current standard treatment includes antibiotics and thoracic ultrasound (TUS)-guided pigtail drainage. Simultaneously with drainage, an intrapleural fibrinolyticum can be given. A potential better alternative is surgery in terms of video-assisted thoracoscopic surgery (VATS) as first-line treatment. The aim of this study is to determine the difference in outcome in patients diagnosed with complex parapneumonic effusion (stage II) and pleural empyema (stage III) who are treated with either VATS surgery or TUS-guided drainage and intrapleural therapy (fibrinolytic (Alteplase) with DNase (Pulmozyme)) as first-line treatment.
METHODS AND ANALYSIS
A national, multicentre randomised, controlled study. Totally, 184 patients with a newly diagnosed community acquired complicated parapneumonic effusion or pleural empyema are randomised to either (1) VATS procedure with drainage or (2) TUS-guided pigtail catheter placement and intrapleural therapy with Actilyse and DNase. The total follow-up period is 12 months. The primary endpoint is length of hospital stay and secondary endpoints include for example, mortality, need for additional interventions, consumption of analgesia and quality of life.
ETHICS AND DISSEMINATION
All patients provide informed consent before randomisation. The research project is carried out in accordance with the Helsinki II Declaration, European regulations and Good Clinical Practice Guidelines. The Scientific Ethics Committees for Denmark and the Danish Data Protection Agency have provided permission. Information about the subjects is protected under the Personal Data Processing Act and the Health Act. The trial is registered at www.
CLINICALTRIALS
gov, and monitored by the regional Good clinical practice monitoring unit. The results of this study will be published in peer-reviewed journals and presented at various national and international conferences.
TRIAL REGISTRATION NUMBER
NCT04095676.
Topics: Deoxyribonucleases; Empyema, Pleural; Fibrinolysis; Fibrinolytic Agents; Humans; Multicenter Studies as Topic; Pleural Effusion; Quality of Life; Randomized Controlled Trials as Topic; Thoracic Surgery, Video-Assisted; Tissue Plasminogen Activator
PubMed: 35264347
DOI: 10.1136/bmjopen-2021-054236 -
Pulmonary Medicine 2020Complicated parapneumonic effusions (CPE) are distinguished from uncomplicated parapneumonic effusions (UPE) by the ability to resolve without drainage. Determinants...
INTRODUCTION
Complicated parapneumonic effusions (CPE) are distinguished from uncomplicated parapneumonic effusions (UPE) by the ability to resolve without drainage. Determinants include pleural pH, pleural glucose, and pleural LDH, along with microbiologic cultures. Inflammation mediated by neutrophil chemotactic cytokines leads to fibrinous loculation of an effusion, and the degree of this inflammation may lead to a CPE. One role of the pathologist is to evaluate for the presence of malignancy in a pleural effusion; however, the ability of the pathologist to distinguish a CPE from UPE has not been evaluated.
MATERIALS AND METHODS
A single-center retrospective study was performed on pleural cytology specimens from 137 patients diagnosed with a parapneumonic effusion or empyema over a five-year interval. Pleural cytology was characterized as either uncomplicated or complicated by two pathologists based on cellular composition and the presence or absence of fibrinous exudate in the fluid. Cohen's kappa was calculated for interobserver agreement. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cytologic diagnoses were calculated. Determinants of cytologic accuracy were assessed using Wilcoxon rank sum test, unpaired -test, and logistic regression.
RESULTS
Kappa interobserver agreement between pathologists was 0.753. Pleural fluid cytology sensitivity, specificity, PPV, and NPV for CPE/empyema were 76.0%, 95% CI [65.0, 84.9]; 50%, 95% CI [29.1, 70.9]; 83.3%, 95% CI [76.7, 88.4]; and 38.7%, 95% CI [26.5, 52.5], respectively. The presence of pleural bacteria, elevated pleural LDH, and reduced pleural pH were nonsignificant determinants of cytologic accuracy. Logistic regression was significant for the presence of pleural bacteria ( = 0.03) in determining a successful cytologic diagnosis.
CONCLUSION
Pleural cytology adds little value to traditional markers of distinguishing a UPE from CPE. Inflammation on pleural fluid cytology is suggestive of empyema or the presence of pleural fluid bacteria.
Topics: Diagnosis, Differential; Empyema, Pleural; Female; Humans; Male; Middle Aged; Pleura; Pleural Effusion; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity
PubMed: 32518695
DOI: 10.1155/2020/7175451 -
Updates in Surgery Apr 2023Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed...
Common complications of coronavirus disease 2019 (COVID-19) related ARDS and ventilation are barotrauma-induced pneumothorax, pneumatocele and/or empyema. We analysed indications and results of video-assisted thoracoscopic surgery (VATS) in complicated COVID-19 patients. This is a retrospective single-institution study analysing a case series of patients treated by VATS for secondary spontaneous pneumothorax (SSP), pneumatocele and empyema complicating COVID-19, not responding to drainage in Lodi Maggiore Hospital between February 2020 and May 2021. Out of 2076 patients hospitalized in Lodi Maggiore Hospital with COVID-19, nine Males (0,43%; mean age 58,1-33-81) were treated by VATS for complications of pneumonia (6 SSP and 3 empyema; 1 case complicated by haemothorax). 7 patients (77%) had CPAP before surgery for 21.3 days mean (4-38). Mean Operative time was 80.9 min (38-154). Conversion rate was 0%. 3 (33%) patients were admitted to ICU before VATS. Treatments were: bullectomy in six patients (66%), drainage of the pleural space in all patients, pleural decortication and fluid aspiration in five cases (55%). two patients (22%) needed surgery interruption and bilateral ventilation to restore adequate oxygenation. Mortality was 1/9 (11%) due to respiratory failure for persistent pneumonia. In one patient (11%) redo surgery was performed for bleeding. Mean postop Length of Stay (LOS) was 37.9 days (10-77). Our report shows that VATS can be considered an extreme, but effective treatment for COVID-19 patients with SSP, pneumatocele or empyema, for patients who can tolerate general anaesthesia. Attention must be paid to the aerosol-generation of infected droplets.
Topics: Male; Humans; Thoracic Surgery, Video-Assisted; Retrospective Studies; Empyema, Pleural; COVID-19; Pneumonia; Length of Stay
PubMed: 36385609
DOI: 10.1007/s13304-022-01420-4 -
European Respiratory Review : An... Sep 2010Pleural infection is a disease of historical importance and is still a modern menace, with incidences rising in adults and children, and a significant mortality in... (Review)
Review
Pleural infection is a disease of historical importance and is still a modern menace, with incidences rising in adults and children, and a significant mortality in adults. Basic research is hampered by limitations with in vivo models, and the bacteriology of empyema is complex. The role of thoracic ultrasound in guiding investigation and drainage of empyema is clear. Prompt treatment with appropriate systemic antibiotics and chest tube drainage are the key; in cases of failure of these measures, thoracic surgery is of proven efficacy in the treatment of this age-old disease.
Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Chest Tubes; Drainage; Empyema, Pleural; Humans; Prevalence
PubMed: 20956197
DOI: 10.1183/09059180.00005610 -
Journal of General Internal Medicine Mar 2014
Topics: Empyema, Pleural; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Nontuberculous Mycobacteria; Tuberculosis
PubMed: 24002629
DOI: 10.1007/s11606-013-2590-2 -
Journal of Clinical and Experimental... Mar 2006In Japan, EBV positive rate in immunocompetent patients with nodal lymphomas is less than 10% in B-cell and 20-50% in T cell lymphoma. Among extranodal lymphomas, EBV... (Review)
Review
In Japan, EBV positive rate in immunocompetent patients with nodal lymphomas is less than 10% in B-cell and 20-50% in T cell lymphoma. Among extranodal lymphomas, EBV positive rate is higher in pyothorax-associated lymphoma (PAL), nasal NK/T-cell lymphoma, and adrenal lymphoma. PAL is non-Hodgkin's lymphoma that develops from chronic pyothorax resulted from artificial pneumothorax for the treatment of lung tuberculosis or tuberculous pleuritis. This disease was originally described by Dr. Aozasa as a distinctive clinicopathologic entity in 1987, and now listed as the disease entity in the WHO classification of Tumours, Pathology & Genetics, Tumours of the Lung, Pleura, Thymus and Heart (2004).
Topics: Empyema, Pleural; History, 20th Century; History, 21st Century; Humans; Japan; Lymphoma, B-Cell; Lymphoma, T-Cell; Nose Neoplasms; Pleural Neoplasms; Pneumothorax; Tuberculosis, Pleural
PubMed: 17058803
DOI: 10.3960/jslrt.46.5 -
Respiratory Medicine Jul 2016An increasing incidence of parapneumonic effusion and pleural empyema (PPE/PE) has been reported in recent studies. As only few data on etiology of PPE/PE in Central... (Observational Study)
Observational Study
BACKGROUND
An increasing incidence of parapneumonic effusion and pleural empyema (PPE/PE) has been reported in recent studies. As only few data on etiology of PPE/PE in Central Europe have been reported, we undertook a study on the etiology of PPE/PE in children, using both standard culture and molecular techniques.
METHODS
This prospective study was conducted between June 2011 and December 2013. Consecutive children with PPE/PE complicating community acquired pneumonia, who required diagnostic/therapeutic thoracentesis were included. Blood and pleural fluid samples for microbiological cultures were collected. Molecular methods were applied to identify Streptococcus pneumonia, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, Mycoplasma pneumoniae, Chlamydophila pneumoniae, and respiratory viruses in pleural fluid.
RESULTS
The study group included 64 children, median age 4 (1-15). Seven of 64 (10.9%) blood cultures and 11 of 64 (17.2%) pleural fluid cultures revealed bacterial growth. The most common bacteria detected was S. pneumoniae (13 blood and pleural fluid samples from 11/64 (17.2%) children). DNA sequences of typical bacteria were found in 29/64 (45.3%) pleural fluid samples. S. pneumoniae was identified in 90% of these samples. The most common serotypes were: serotype 6B in 9/26 (36.6%), 19A in 6/26 (23%), serotype 3 in 3/26 (11.5%), 6A and 23F (both in 2/26 i.e. 7.7%) patients. Molecular methods identified atypical bacteria in 8/58 (13.8%) and respiratory viruses in 12/58 (20.7%) pleural fluid samples.
CONCLUSIONS
S. pneumoniae, in particular serotype 6B and 19A, is the most common etiologic agent of PPE/PE in Polish children. The use of PCR significantly improves pathogen identification in pleural fluid.
Topics: Administration, Intravenous; Adolescent; Anti-Infective Agents; Bacteriological Techniques; Child; Child, Preschool; Chlamydophila pneumoniae; Community-Acquired Infections; Empyema, Pleural; Europe; Female; Haemophilus influenzae; Humans; Incidence; Infant; Male; Molecular Diagnostic Techniques; Mycoplasma pneumoniae; Pleura; Pleural Effusion; Poland; Polymerase Chain Reaction; Prospective Studies; Serotyping; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes; Thoracentesis
PubMed: 27296817
DOI: 10.1016/j.rmed.2016.05.009 -
Pediatric Radiology Nov 2022While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these...
BACKGROUND
While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these children.
OBJECTIVE
Standardizing fibrinolytic administration among interventional radiology (IR) physicians to improve patient outcomes in pediatric parapneumonic effusion.
MATERIALS AND METHODS
We introduced a hospital-wide clinical pathway for parapneumonic effusion (1-2 mg tissue plasminogen activator [tPA] twice daily based on pleural US grade); we then collected prospective data for IR treatment May 2017 through February 2020. These data included demographics, co-morbidities, pediatric intensive care unit (PICU) admission, pleural US grade, culture results, daily tPA dose average, twice-daily dose days, skipped dose days, pleural therapy days, need for chest CT/a second IR procedure/surgical drainage, and length of stay. We compared the prospective data to historical controls with IR treatment from January 2013 to April 2017.
RESULTS
Sixty-three children and young adults were treated after clinical pathway implementation. IR referrals increased (P = 0.02) and included higher co-morbidities (P = 0.005) and more PICU patients (P = 0.05). Mean doses per day increased from 1.5 to 1.9 (P < 0.001), twice-daily dose days increased from 38% to 79% (P < 0.001) and median pleural therapy days decreased from 3.5 days to 2.5 days (P = 0.001). No IR patients needed surgical intervention. No statistical differences were observed for gender/age/weight, US grade, need for a second IR procedure or length of stay. US grade correlated with greater positive cultures, need for chest CT/second IR procedure, and pleural therapy days.
CONCLUSION
Interventional radiology physician standardization improved on a clinical pathway for fibrinolysis of parapneumonic effusion. Despite higher patient complexity, pleural therapy duration decreased. There were no chest tube failures needing surgical drainage.
Topics: Young Adult; Humans; Child; Tissue Plasminogen Activator; Empyema, Pleural; Prospective Studies; Pleural Effusion; Thrombolytic Therapy; Fibrinolytic Agents; Retrospective Studies
PubMed: 35451632
DOI: 10.1007/s00247-022-05365-z -
Canadian Medical Association Journal Nov 1952
Topics: Amebiasis; Dysentery, Amebic; Empyema; Empyema, Pleural; Humans; Pleura
PubMed: 13009594
DOI: No ID Found