@article {FergusonPA3836, author = {Katie Ferguson and Kevin Blyth and Selina Tsim}, title = {IPC-related pleural infection vs. colonisation - to treat or not to treat?}, volume = {54}, number = {suppl 63}, elocation-id = {PA3836}, year = {2019}, doi = {10.1183/13993003.congress-2019.PA3836}, publisher = {European Respiratory Society}, abstract = {Introduction: Reported rates of Indwelling Pleural Catheter (IPC)-related pleural infection range from 0-12\%, but it can be difficult to distinguish infection from colonisation. The latter is of critical importance with intra-pleural immunotherapies entering trials, e.g. in Mesothelioma (MPM). We report the rate of antibiotic receipt for suspected infection, and patterns potentially suggestive of colonisation.Methods: IPC cases were reviewed retrospectively (2010-2018). Cases who received antibiotics were dichotomised into {\textquoteleft}early/{\textquoteright}late{\textquoteright} (antibiotic receipt <=/\>4 weeks). {\textquoteleft}Late{\textquoteright} cases were further dichotomised into those with/without post hoc criteria for likely true infection: fever, frank pus or \>50\% CRP rise. Underlying tumour type, cultures and treatment were compared.Results: 19/80 (24\%) cases received antibiotics. 89\% had positive cultures; 0\% had fever or frank pus. Surgery and mortality rates were 0\%. Median time to treatment was 13 (IQR 5 {\textendash} 39) weeks. 15/19 (79\%) cases were classified as {\textquoteleft}late{\textquoteright}.3/4 (75\%) cultures in {\textquoteleft}early{\textquoteright} cases yielded Staphylococci. {\textquoteleft}Late{\textquoteright} case cultures yielded various organisms. MPM was more common in {\textquoteleft}late{\textquoteright} (60\%) than {\textquoteleft}early{\textquoteright} cases (25\%).11/19 (58\%) met post hoc criteria for likely true infection, all based on CRP rise. 5/8 (63\%) of cases not meeting these criteria cultured gram negative organisms or coagulase negative Staphylococci, in whom treatment was often conservative (50\% oral antibiotics only).Conclusion: Rates of antibiotic receipt were higher than in previous series. Positive culture rate was high, suggesting most patients were treated for positive cultures. {\textquoteleft}Late{\textquoteright} cases commonly had MPM and potentially non-pathogenic organisms. IPC colonisation rates require prospective study.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA3836.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).}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/54/suppl_63/PA3836}, eprint = {https://erj.ersjournals.com/content}, journal = {European Respiratory Journal} }