No abstract

We are an established pleural centre offering medical thoracoscopy and indwelling pleural catheters. Our infection rates with prophylactic antibiotics were lower than the national average and given the era of antibiotic stewardship and lack of evidence to support the administration, we stopped giving them. We then noticed a large jump in infection rates and hence, in this paper, we reviewed our practice.vious endocarditis and this is based on expert opinion only [1]. Nuttal et al. [7] have presented that prophylactic doxycycline following IPC insertion for malignant pleural effusions probably reduced their infection rate. More recently, Dhooria, et al. [8] randomised 100 patients to receive either cefazolin or intravenous saline. The infection rate in the antibiotic group did not reduce, even after all the variables were controlled for. This is the only randomised controlled trial to date. Review of Local PracticeWe run a well established, safe and streamlined pleural service, serving over 500,000 patients across 3 different sites. We have previously published our low infection and high sensitivity rates of IPCs and MT respectively following a review of all procedures done from 2010 to 2015 [6]. We then did all our procedures in theatre under strict aseptic conditions, and recommended a pre-op single dose of prophylactic antibiotics.In 168 cases of MT, we had three pleural space infections (1.7%) and two wound infections (1%). Our diagnostic sensitivity was 97%, which is higher than other quoted figures. In 70 patients with IPCs, 96% had prophylactic antibiotics pre-procedure and three (4%) developed late pleural space infections. All three required intravenous antibiotics. One had cellulitis around the insertion site and required drain removal and the others received intrapleural fibrinolytics according to the MIST 2 protocol to clear their pleural space.As such, in January 2015, we stopped giving prophylactic antibiotics prior to such procedures. There are no national guidelines for this, so this was agreed locally between the pleural consultants.