Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study

Deirdre B Fitzgerald; Sanjeevan Muruganandan; Selina Tsim; Hugh Ip; Rachelle Asciak; Steven Walker; Juan-Pablo Uribe Becerra; Adnan Majid; Liju Ahmed; Najib M Rahman; Nick A Maskell; Kevin G Blyth; Y C Gary Lee

doi:10.1159/000514643

Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study

Deirdre B Fitzgerald, Sanjeevan Muruganandan, Selina Tsim, Hugh Ip, Rachelle Asciak, Steven Walker, Juan-Pablo Uribe Becerra, Adnan Majid, Liju Ahmed, Najib M Rahman, Nick A Maskell, Kevin G Blyth, Y C Gary Lee^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

11 Citations (Scopus)

Abstract

BACKGROUND: Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce.

OBJECTIVE: To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection.

METHODS: Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on feasibility of intrapleural tPA/DNase delivery, its efficacy and safety were recorded.

RESULTS: Thirty-nine IPC-related pleural infections (predominantly Staphylococcus aureus and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3-6]/patient) of tPA (2.5 mg-10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding.

CONCLUSION: Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.

Original language	English
Pages (from-to)	452-460
Number of pages	9
Journal	Respiration
Volume	100
Issue number	5
Early online date	30 Mar 2021
DOIs	https://doi.org/10.1159/000514643
Publication status	Published - 1 May 2021

Bibliographical note

Research Groups and Themes

Academic Respiratory Unit

Keywords

Aged
Catheters, Indwelling/adverse effects
Deoxyribonucleases/administration & dosage
Drug Therapy, Combination
Empyema, Pleural/microbiology
Female
Fibrinolytic Agents/administration & dosage
Humans
Leukocyte Count
Male
Middle Aged
Pleural Diseases/drug therapy
Pleural Effusion/microbiology
Respiratory Tract Infections/drug therapy
Tissue Plasminogen Activator/administration & dosage

Access to Document

10.1159/000514643

Handle.net

Persistent link

Cite this

Fitzgerald, D. B., Muruganandan, S., Tsim, S., Ip, H., Asciak, R., Walker, S., Uribe Becerra, J.-P., Majid, A., Ahmed, L., Rahman, N. M., Maskell, N. A., Blyth, K. G., & Lee, Y. C. G. (2021). Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study. Respiration, 100(5), 452-460. https://doi.org/10.1159/000514643

@article{fbb1cbd8fe5a4f199291c7aaba426764,

title = "Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study",

abstract = "BACKGROUND: Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce.OBJECTIVE: To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection.METHODS: Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on feasibility of intrapleural tPA/DNase delivery, its efficacy and safety were recorded.RESULTS: Thirty-nine IPC-related pleural infections (predominantly Staphylococcus aureus and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3-6]/patient) of tPA (2.5 mg-10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding.CONCLUSION: Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.",

keywords = "Aged, Catheters, Indwelling/adverse effects, Deoxyribonucleases/administration & dosage, Drug Therapy, Combination, Empyema, Pleural/microbiology, Female, Fibrinolytic Agents/administration & dosage, Humans, Leukocyte Count, Male, Middle Aged, Pleural Diseases/drug therapy, Pleural Effusion/microbiology, Respiratory Tract Infections/drug therapy, Tissue Plasminogen Activator/administration & dosage",

author = "Fitzgerald, {Deirdre B} and Sanjeevan Muruganandan and Selina Tsim and Hugh Ip and Rachelle Asciak and Steven Walker and {Uribe Becerra}, Juan-Pablo and Adnan Majid and Liju Ahmed and Rahman, {Najib M} and Maskell, {Nick A} and Blyth, {Kevin G} and Lee, {Y C Gary}",

note = "{\textcopyright} 2021 S. Karger AG, Basel.",

year = "2021",

month = may,

day = "1",

doi = "10.1159/000514643",

language = "English",

volume = "100",

pages = "452--460",

journal = "Respiration",

issn = "0025-7931",

publisher = "Karger Publishers",

number = "5",

}

Fitzgerald, DB, Muruganandan, S, Tsim, S, Ip, H, Asciak, R, Walker, S, Uribe Becerra, J-P, Majid, A, Ahmed, L, Rahman, NM, Maskell, NA, Blyth, KG & Lee, YCG 2021, 'Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study', Respiration, vol. 100, no. 5, pp. 452-460. https://doi.org/10.1159/000514643

Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study. / Fitzgerald, Deirdre B; Muruganandan, Sanjeevan; Tsim, Selina et al.
In: Respiration, Vol. 100, No. 5, 01.05.2021, p. 452-460.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection

T2 - A Multi-Center Observational Study

AU - Fitzgerald, Deirdre B

AU - Muruganandan, Sanjeevan

AU - Tsim, Selina

AU - Ip, Hugh

AU - Asciak, Rachelle

AU - Walker, Steven

AU - Uribe Becerra, Juan-Pablo

AU - Majid, Adnan

AU - Ahmed, Liju

AU - Rahman, Najib M

AU - Maskell, Nick A

AU - Blyth, Kevin G

AU - Lee, Y C Gary

PY - 2021/5/1

Y1 - 2021/5/1

N2 - BACKGROUND: Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce.OBJECTIVE: To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection.METHODS: Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on feasibility of intrapleural tPA/DNase delivery, its efficacy and safety were recorded.RESULTS: Thirty-nine IPC-related pleural infections (predominantly Staphylococcus aureus and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3-6]/patient) of tPA (2.5 mg-10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding.CONCLUSION: Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.

AB - BACKGROUND: Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce.OBJECTIVE: To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection.METHODS: Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on feasibility of intrapleural tPA/DNase delivery, its efficacy and safety were recorded.RESULTS: Thirty-nine IPC-related pleural infections (predominantly Staphylococcus aureus and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3-6]/patient) of tPA (2.5 mg-10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding.CONCLUSION: Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.

KW - Aged

KW - Catheters, Indwelling/adverse effects

KW - Deoxyribonucleases/administration & dosage

KW - Drug Therapy, Combination

KW - Empyema, Pleural/microbiology

KW - Female

KW - Fibrinolytic Agents/administration & dosage

KW - Humans

KW - Leukocyte Count

KW - Male

KW - Middle Aged

KW - Pleural Diseases/drug therapy

KW - Pleural Effusion/microbiology

KW - Respiratory Tract Infections/drug therapy

KW - Tissue Plasminogen Activator/administration & dosage

U2 - 10.1159/000514643

DO - 10.1159/000514643

M3 - Article (Academic Journal)

C2 - 33784710

SN - 0025-7931

VL - 100

SP - 452

EP - 460

JO - Respiration

JF - Respiration

IS - 5

ER -

Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study

Abstract

Bibliographical note

Research Groups and Themes

Keywords

Access to Document

Handle.net

Fingerprint

Cite this