SESSION TYPE: Pleural Disease
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: IPCs are increasingly used for management of recurrent, especially malignant, pleural effusions (MPE). Concern about pleural and skin infections is one of the major barriers to their use. This study sought to identify predisposing factors, optimum treatment and outcomes of IPC associated infection.
METHODS: All members of the Thoracic Society of Australia & New Zealand were contacted, as well as several pulmonology centers in North America and the UK with published records of IPC research expertise. Information on overall incidence, microbiology causes, treatment and outcome for pleural infection were analyzed.
RESULTS: Eight centers in Australia (n=3), Canada (1), USA (1) and UK (3) provided retrospective audit data. A total of 881 patients received an IPC over a 10-year period from August 2001. All patients had malignant effusions. All patients were followed up till death or a minimum of 126 days. 40 (4.5%) patients developed an IPC-related pleural infection and 12 (1.4%) had cellulitis. Pleural infection developed after a median of 67 (IQR 40-191) days after IPC insertion often at a time of advanced disease (median 262 days after the diagnosis of MPE). IPC-related pleural infection was successfully treated in 93% and cellulitis in 100% of cases. Staphylococcus aureus was the most common bacterium in IPC-related pleural infection (18/40, 45%). Most (72.5%) patients with IPC-related pleural infection required inpatient care and antibiotics (intravenous in 65% cases). Flucloxacillin or tazocin (9/40, 22.5% each) were the most common antimicrobials used. Patients received antibiotics for a median of 31 (IQR 16 to 42) days. Two-thirds of the patients developed pleurodesis after the pleural infection allowing removal of the IPCs. Only 3 of all the IPC patients (0.3%) had deaths attributable to pleural infection.
CONCLUSIONS: IPC infections are uncommon, easily treated with common antibiotics, and are often associated with spontaneous pleurodesis afterwards.
CLINICAL IMPLICATIONS: IPC-related infection is rare, and usually developed more than 6 weeks after IPC insertion. IPC-related pleural infection is usually easily treatable with antibiotics. Major morbidity and death from infection are uncommon with IPC use and should not deter its use in suitable patients.
DISCLOSURE: The following authors have nothing to disclose: Andrew Rosenstengel, Alain Tremblay, Edward Fysh, YC Gary Lee, Luke Garske, Ben Ng, Mark Slade, Eleanor Mishra, Amelia Dunscombe, Carla Lamb, Nick Maskell
No Product/Research Disclosure InformationSir Charles Gairdner Hospital, Perth, WA, Australia