Pleural infection: What we need to know but don't

Current Opinion in Pulmonary Medicine

Volumn 18, Issue 4, 2012, Pages 321-325

  Tobin, Claire L ^a   Lee, Y C Gary ^a,b,c  

^a SIR CHARLES GAIRDNER HOSPITAL   (Australia)

^b Lung Institute of Western Australia   (Australia)

^c UNIVERSITY OF WESTERN AUSTRALIA   (Australia)

Author keywords

diagnosis; empyema; etiology; pleural infection; treatment

Indexed keywords

AMINOGLYCOSIDE; ANTIBIOTIC AGENT; GENTAMICIN; METRONIDAZOLE; PENICILLIN G; TISSUE PLASMINOGEN ACTIVATOR;

BACTERIOLOGY; CLINICAL PRACTICE; DIAGNOSTIC PROCEDURE; HEALTH CARE; HUMAN; MEDICAL LITERATURE; MORTALITY; NONHUMAN; PATHOPHYSIOLOGY; PLEURA DRAINAGE; PLEURA EMPYEMA; PLEURISY; REVIEW; STREPTOCOCCUS ANGINOSUS; STREPTOCOCCUS CONSTELLATUS; STREPTOCOCCUS INTERMEDIUS; SURGICAL DRAINAGE; VIDEO ASSISTED THORACOSCOPIC SURGERY;

EMPYEMA, PLEURAL; HUMANS; INCIDENCE; PLEURA; PNEUMONIA; STREPTOCOCCAL INFECTIONS;

EID: 84862187107     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/MCP.0b013e328352c673     Document Type: Review

References (36)

1. Li S, Tancredi D. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics 2010; 125:26-33.
2. Goldbart A, Leibovitz E, Porat N, et al. Complicated community acquired pneumonia in children prior to the introduction of the pneumococcal conjugate vaccine. Scand J Infect Dis 2009; 41:182-187.
3. Wu P, Huang L, Chang I, et al. The epidemiology of hospitalized children with pneumococcal/lobar pneumonia and empyema from 1997 to 2004 in Taiwan. Eur J Paediatr 2010; 169:861-866.
4. Finley C, Clifton J, Fitzgerald J, et al. Empyema: An increasing concern in Canada. Can Respir J 2008; 15:85-89.
5. Farjah F, Symons R, Krishnadasan B, et al. Management of pleural space infections: A population-based analysis. J Thorac Cardiovasc Surg 2007; 133:346-351.
6. Bender J, Ampofo K, Sheng X, et al. Parapneumonic empyema deaths during past century, Utah. Emerg Infect Dis 2009; 15:44-48.
7. Wilkosz S, Edwards LA, Bielsa S, et al. Characterization of a new mouse model of empyema and the mechanisms of pleural invasion by Streptococcus pneumoniae. Am J Respir Cell Mol Biol 2012; 46:1-8.This study describes a new murine mouse model of pneumonia-associated empyema due to S. pneumoniae. Using the model, the sequence of key events in the development of empyema is described and the study demonstrates that the pleural space is permissive for bacterial infection. The development of such a model is important for future investigation of the pathogenesis of empyema and pleural immunological responses to infection.
8. Maskell NA, Davies CW, Nunn AJ, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005; 352:865-874.
9. Gonzalez BE, Hulten KG, Dishop MK, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus infection. Clin Infect Dis 2005; 41:583-590.
10. Carrillo-Marquez MA, Hulten KG, Hammerman W, et al. Staphylococcus aureus pneumonia in children in the era of community-acquired methicillinresistance at Texas Children's Hospital. Pediatr Infect Dis J 2011; 30:545-550.
11. Lisboa T, Waterer G, Lee YCG. Pleural infection: Changing bacteriology and its implications. Respirology 2011; 16:598-603. This review article discusses the changing bacteriology of pleural infection, comparing adult vs. paediatric patients, community vs. nosocomial-acquired empyema and global variations. Changing pneumococcal serotypes and the impact of vaccination are also detailed.
12. Hendrickson D, Blumberg D, Joad J, et al. Five-fold increase in pediatric parapneumonic empyema since introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J 2008; 41:182-187.
13. Burgos J, Lugan M, Falco V, et al. The spectrum of pneumococcal empyema in adults in the early 21st century. Clin Infect Dis 2011; 53:254-261.
14. Chalmers LD, Singanayagam A, Murray MP, et al. Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax 2009; 64:592-597.
15. Thomson AH. Pleural infection in children. International Pleural Newsletter 2006; 4:7-8.
16. Menzies SM, Rahman NM, Wrightson JM, et al. Blood culture bottle culture of pleural fluid in pleural infection. Thorax 2011; 66:658-662. This study demonstrates an increase in the microbiological yield from pleural fluid by 20.8% when blood culture bottle culture is used in addition to standard laboratory culture. This technique should be part of routine clinical care.
17. Strachan RE, Cornelius A, Neo PI, et al. Pleural fluid nucleic acid testing enhances pneumococcal surveillance in children. Respirology 2012; 17:114-119.
18. Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural fluid infection by genetic and standard methods and its mortality significance. Am J Resp Crit Care Med 2006; 174:817-823.
19. Diacon AH, Van De Wal BW, Wyser C, et al. Diagnostic tools in tuberculous pleurisy: A direct comparative study. Eur Resp J 2003; 22:589-591.
20. Tobin C, Porcel J, Wrightson J, et al. Diagnosis of pleural infection: State-ofthe-art. Curr Respir Care Report 2012 (in press).
21. Marchi E, Vargas FS, Acencio MM, et al. Pro-and anti-inflammatory cytokines levels in complicated and noncomplicated parapneumonic effusions. Chest 2012; 141:183-189.
22. Porcel JM, Vives M, Cao G, et al. Biomarkers of infection in pleural fluid for the differential diagnosis of pleural effusions. Eur Respir J 2009; 34:1383-1389.
23. Munoz-Almagro C, Gala S, Selva L, et al. DNA bacterial load in children and adolescents with pneumococcal pneumonia and empyema. Eur J Clin Microbiol Infect Dis 2011; 30:327-335.
24. Teixeira LR, Sasse SA, Villarino MA, et al. Antibiotic levels in empyemic pleural fluid. Chest 2000; 117:1734-1739.
25. Thys JP, Vanderhoeft P, Herchuelz A, et al. Penetration of aminoglycosides in uninfected pleural exudates and in pleural empyema. Chest 1988; 93:530-532.
26. Molnar TF. Current surgical treatment of thoracic empyema in adults. Eur J Cardiothorac Surg 2007; 32:422-430.
27. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and videoassisted thorcoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med 2006; 174:221-227.
28. St Peter SD, Tsao K, Spilde TL, et al. Thoracoscopic decortication vs. tube thoracostomy with fibrinolytics for empyema in children: A prospective, randomized trial. J Pediatr Surg 2009; 44:106-111.
29. Bilgin M, Akcali Y, Oguzkaya F. Benefits of early aggressive management of empyema thoracics. ANZ J Surg 2006; 76:120-122.
30. Wait MA, Sharma S, Hohn J, et al. A randomized trial of empyema therapy. Chest 1997; 111:1548-1551.
31. Davies H, Rosenstengel A, Lee YC Gary. The diminishing role of surgery in pleural disease. Curr Opin Pulm Med 2011; 17:247-254.
32. Brims FJ, Davies HE, Lee YCG. Respiratory chest pain: Diagnosis and treatment. Med Clin North Am 2010; 94:217-232.
33. Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Eng J Med 2011; 365:518-526.Following on from the MIST-1 study, this blinded, two-by-two factorial randomized controlled trial of 210 patients with pleural infection showed that intrapleural tPA and DNase therapy, in combination improved fluid drainage, reduced the frequency of surgical referral and duration of hospital stay. Similar outcomes with either tPA or DNase alone were not seen.
34. Ng T, Ryder BA, Maziak DE, et al. Treatment of postpneumonectomy empyema with debridement followed by continuous antibiotic irrigation. J Am Coll Surg 2008; 206:1178-1183.
35. Mennander A, Laurrika J, Kuukasjarvi P, et al. Continous pleural lavage may decrease postoperative morbidity in patients undergoing thoracotomy for stage 2 thoracic empyema. Eur J Cardiothorac Surg 2005; 27:32-34.
36. Mullins MM, Walker I, Standridge RD. Using povidone-iodine to treat empyema. J of Wound Care 2001; 10:155-156.