title: Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study.
abstract: 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.
authors.affiliation: Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; Centre for Asthma, Allergy, and Respiratory Research, and the School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors.forename: Edward T H
authors.initials: ETH
authors.lastname: Fysh
authors.affiliation: Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
authors.forename: Eleanor K
authors.initials: EK
authors.lastname: Mishra
authors.affiliation: Department of Thoracic Oncology, Papworth Hospital, Cambridge, England.
authors.forename: Mark
authors.initials: M
authors.lastname: Slade
authors.affiliation: Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Garske
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England.
authors.forename: Amelia O
authors.initials: AO
authors.lastname: Clive
authors.affiliation: Lahey Clinic, Burlington, MA.
authors.forename: Carla
authors.initials: C
authors.lastname: Lamb
authors.affiliation: Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Rogier
authors.initials: R
authors.lastname: Boshuizen
authors.affiliation: Nepean Hospital Lung Cancer Multidisciplinary Group, Sydney, NSW, Australia.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Ng
authors.affiliation: Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Rosenstengel
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.affiliation: Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Maskell
authors.affiliation: Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; Centre for Asthma, Allergy, and Respiratory Research, and the School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia. Electronic address: gary.lee@uwa.edu.au.
authors.forename: Y C Gary
authors.initials: YCG
authors.lastname: Lee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009656:North America / Q000453:epidemiology; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D018700:Pleurodesis / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D000900:Anti-Bacterial Agents