Abstract
Indwelling pleural catheter (IPC)-related pleural infection, though uncommon, remains a major concern. Intrapleural tPA/DNase improved non-IPC pleural infection outcomes and reduced surgical referrals but its use in IPC-related infection has not been reported.
A retrospective review of IPC infections treated with tPA/DNase was performed at 6 specialist pleural units across Australia, UK and USA to determine the safety and efficacy of this approach. Demographics, treatment and outcomes are reported. Treatment success is defined as survival to discharge without surgery.
tPA/DNase was used to treat 52 IPC-related infections from 2008-2018. Follow-up to death or last clinic post-infection was a median of 91 [30.25–271] days. The majority were malignant effusions (89%). IPC infection occurred at a median of 64 [13–137] days post-insertion. Presenting features included reduced IPC output (61%), fever (54%) and fluid purulence (48%). Pleural fluid cultures were positive in 87% of patients, predominantly S. Aureus (31%) and gram-negative bacilli (42%). All patients were treated with intravenous antibiotics (85% beta lactams) for a median of 15 [11.5–25.5] days. The median number of tPA/DNase doses was 3.5 (2–6).
Treatment was successful in 87%. Two patients underwent successful VATS and 5 patients, all of whom had advanced cancer or comorbidities, died. Fifteen patients (28.8%) required a drainage procedure. IPC was removed in 36 patients (77.8% were due to pleurodesis). There were no major complications of treatment.
Intrapleural tPA/DNase therapy can be safely administered via IPC for pleural infection and appears to be effective.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA3835.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019