A systematic review of comorbidities and outcomes of adult patients with pleural infection

Cargill, Tamsin; Hassan, Maged; Corcoran, John; Harriss, Elinor; Asciak, Rachelle; Mercer, Rachel; McCracken, David J.; Bedawi, Eihab; Rahman, Najib M.

doi:10.1183/13993003.00541-2019

Cited by 49 publications

(45 citation statements)

References 128 publications

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“…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. 17 The same systematic review found high prevalence of comorbidity in patients with pleural infection (median prevalence 72%), with no difference in prevalence between patients from high-income and lower-income countries.…”

Section: Epidemiologymentioning

confidence: 92%

“…This probably reflects the multimorbidity effects in an aging population in which the incidence of pleural infection could be consequential. 17,20,108 It should be noted, however, that this demographic characterization applies to reports mostly from high-income countries, with relatively insufficient evidence of a similar picture in lower-income countries.…”

Section: Dovepressmentioning

confidence: 93%

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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: 92%

Section: Dovepressmentioning

confidence: 93%

Recent Insights into the Management of Pleural Infection

Hassan

Patel

Sadaka

et al. 2021

IJGM

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“…The surgical literature would suggest that there is still a clear selection bias giving preference to younger patients with fewer comorbidities (rather than severity of their condition) whom, by virtue of their underlying fitness, may have had a greater chance of overcoming their illness [3,46]. We recently reported that regions with higher income economies, patients with pleural infection were older with higher in-hospital mortality [50]. The increasing use of IET means that fewer patients are now referred to surgery but despite evidence of it being cost-effective in a recent health economics analysis of MIST-2 [51], it still does carry a significant cost, which means it is difficult to justify for all patients.…”

Section: Surgerymentioning

confidence: 99%

Advances in pleural infection and malignancy

Bedawi

Guinde²,

Rahman

et al. 2021

Eur Respir Rev

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Pleural infection and malignancy are among the most common causes of pleural disease and form the mainstay of pleural practice. There has been significant research and increase in scientific understanding in these areas in the past decade. With regard to pleural infection, the rising incidence remains worrying. An increased awareness allowing earlier diagnosis, earlier escalation of therapy and the use of validated risk stratification measures may improve outcomes. In pleural malignancy, research has enabled clinicians to streamline patient pathways with focus on reducing time to diagnosis, definitive management of malignant pleural effusion and achieving these with the minimum number of pleural interventions. Trials comparing treatment modalities of malignant pleural effusion continue to highlight the importance of patient choice in clinical decision-making. This article aims to summarise some of the most recent literature informing current practice in these two areas.

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“…In parallel, little progress has been made in terms of improving outcomes over the last two decades [9,10]. Pleural infection is often associated with considerable morbidity and a recent systematic review demonstrated the high prevalence of pre-existing comorbidity (median 72%) [11]. Mortality exceeds that of myocardial infarction [12].…”

Section: Introductionmentioning

confidence: 99%

“…The largest population-based cohort study of pleural infection recently reported a 30-day mortality of 10% [8] whilst a recent outcome study of >600 patients from Western Australia found a one-year mortality of up to 32% [13]. Worldwide, the average length of hospital stay is 19 days [11] with significant healthcare resource utilization. The financial burden on the National Health Service in the United Kingdom, for inpatient costs alone, is estimated at £90 million per year and reported figures in the United States are close to half a billion dollars annually [9].…”

Section: Introductionmentioning

confidence: 99%