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Original Research: Pulmonary Procedures |

Clinical Outcomes of Indwelling Pleural Catheter-Related Pleural InfectionsIndwelling Pleural Catheter-Related Infections: An International Multicenter Study

Edward T. H. Fysh, MBBS BSc; Alain Tremblay, MDCM, FCCP; David Feller-Kopman, MD, FCCP; Eleanor K. Mishra, MD; Mark Slade, MBBS, FCCP; Luke Garske, MBBS; Amelia O. Clive, MBBS BSc; Carla Lamb, MD, FCCP; Rogier Boshuizen, MD; Benjamin J. Ng, MBBS; Andrew W. Rosenstengel, MD, FCCP; Lonny Yarmus, DO, FCCP; Najib M. Rahman, DPhil; Nick A. Maskell, DM, FCCP; Y. C. Gary Lee, PhD, FCCP
Author and Funding Information

From the Pleural Diseases Unit (Drs Fysh and Rosenstengel and Prof Lee), Sir Charles Gairdner Hospital, Perth, WA, Australia; the Centre for Asthma, Allergy, and Respiratory Research (Dr Fysh and Prof Lee), and the School of Medicine and Pharmacology (Dr Fysh and Prof Lee), University of Western Australia, Perth, WA, Australia; the Division of Respiratory Medicine (Dr Tremblay), University of Calgary, Calgary, AB, Canada; the Division of Pulmonary and Critical Care Medicine (Drs Feller-Kopman and Yarmus), Johns Hopkins Hospital, Baltimore, MD; the Oxford Respiratory Trials Unit (Drs Mishra and Rahman), Churchill Hospital, Oxford, England; the Department of Thoracic Oncology (Dr Slade), Papworth Hospital, Cambridge, England; the Princess Alexandra Hospital (Dr Garske), Brisbane, QLD, Australia; the Academic Respiratory Unit (Drs Clive and Maskell), School of Clinical Sciences, University of Bristol, Bristol, England; the Lahey Clinic (Dr Lamb), Burlington, MA; the Netherlands Cancer Institute (Dr Boshuizen), Amsterdam, The Netherlands; and the Nepean Hospital Lung Cancer Multidisciplinary Group (Dr Ng), Sydney, NSW, Australia.

Correspondence to: Y. C. Gary Lee, PhD, FCCP, University Department of Medicine, QE II Medical Centre, Perth, WA 6009, Australia; e-mail: gary.lee@uwa.edu.au


Funding/Support: Dr Fysh receives scholarships from the NHMRC and the Lung Institute of Western Australia and a research project grant from the New South Wales Dust Disease Board. Prof Lee receives research funding from the National Health and Medical Research Council (NHMRC), New South Wales Dust Disease Board, the Sir Charles Gairdner Research Advisory Committee, and the Cancer Council of Western Australia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1597-1602. doi:10.1378/chest.12-3103
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Background:  Indwelling pleural catheters (IPCs) offer effective control of malignant pleural effusions (MPEs). IPC-related infection is uncommon but remains a major concern. Individual IPC centers see few infections, and previous reports lack sufficient numbers and detail. This study combined the experience of 11 centers from North America, Europe, and Australia to describe the incidence, microbiology, management, and clinical outcomes of IPC-related pleural infection.

Methods:  This was a multicenter retrospective review of 1,021 patients with IPCs. All had confirmed MPE.

Results:  Only 50 patients (4.9%) developed an IPC-related pleural infection; most (94%) were successfully controlled with antibiotics (62% IV). One death (2%) directly resulted from the infection, whereas two patients (4%) had ongoing infectious symptoms when they died of cancer progression. Staphylococcus aureus was the causative organism in 48% of cases. Infections from gram-negative organisms were associated with an increased need for continuous antibiotics or death (60% vs 15% in gram-positive and 25% mixed infections, P = .02). The infections in the majority (54%) of cases were managed successfully without removing the IPC. Postinfection pleurodesis developed in 31 patients (62%), especially those infected with staphylococci (79% vs 45% with nonstaphylococcal infections, P = .04).

Conclusions:  The incidence of IPC-related pleural infection was low. The overall mortality risk from pleural infection in patients treated with IPC was only 0.29%. Antibiotics should cover S aureus and gram-negative organisms until microbiology is confirmed. Postinfection pleurodesis is common and often allows removal of IPC. Heterogeneity in management is common, and future studies to define the optimal treatment strategies are needed.

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