Journal of bronchology & interventional pulmonology · 2025
A Multicenter Analysis of Factors Predicting Treatment Success for Intrapleural Enzyme Therapy for Pleural Infection.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Boppana Leela Krishna Teja, Ferreira Jason, Menendez Manuel, Mehta Hiren J, Baerga Carlos Gonzalez, Hernandez Mauricio, Harmon Taylor, Izzo Christopher, Wynn Gregory, Garvan Gerard, Ashby Tracy
Аннотация
BACKGROUND: Pleural infection results from bacterial entry and replication in the pleural space. Patients with pleural infection are a challenging subset, where appropriate antibiotic therapy, tube thoracostomy drainage, intrapleural enzymatic therapy (IET), and surgery are cornerstones of management. The factors influencing IET success remain unclear. A retrospective analysis of patients who received IET for pleural infection in our health system was conducted to identify factors associated with treatment outcomes.
METHODS: The electronic health record was queried for dispense and administration of intrapleural tPA and DNase between January 2018 and May 2024. Patients were included if they were over 18 years old with complicated parapneumonic effusion/empyema, had a CT chest within 1 day before thoracostomy tube insertion, received IET and had a follow-up CT chest within 7 days after the last IET dose. Volumetric analysis was performed for all patients. The clinical outcome was treatment success (clinical and radiologic improvement without need for surgical intervention).
RESULTS: Of 185 patients included in the final analysis, 57 patients had treatment failure. The mean age was 56.8 years and were predominantly males. Pleural fluid biochemistry showed median pH and LDH were 7.00 and 1129 U/L. Streptococcus species was the most common microbe in pleural cultures. Multivariable logistic regression analysis showed that a community source of infection was associated with treatment success, while a hospital source of infection was associated with a 71% risk of treatment failure [OR: 0.287 (95% CI: 0.115, 0.690); P = 0.006].
CONCLUSION: A community source of infection predicted treatment success with IET in our cohort.
METHODS: The electronic health record was queried for dispense and administration of intrapleural tPA and DNase between January 2018 and May 2024. Patients were included if they were over 18 years old with complicated parapneumonic effusion/empyema, had a CT chest within 1 day before thoracostomy tube insertion, received IET and had a follow-up CT chest within 7 days after the last IET dose. Volumetric analysis was performed for all patients. The clinical outcome was treatment success (clinical and radiologic improvement without need for surgical intervention).
RESULTS: Of 185 patients included in the final analysis, 57 patients had treatment failure. The mean age was 56.8 years and were predominantly males. Pleural fluid biochemistry showed median pH and LDH were 7.00 and 1129 U/L. Streptococcus species was the most common microbe in pleural cultures. Multivariable logistic regression analysis showed that a community source of infection was associated with treatment success, while a hospital source of infection was associated with a 71% risk of treatment failure [OR: 0.287 (95% CI: 0.115, 0.690); P = 0.006].
CONCLUSION: A community source of infection predicted treatment success with IET in our cohort.