title: Intrapleural Antimicrobial Irrigation for Postpneumonectomy Empyema in Patients With Lung Cancer.
abstract: OBJECTIVE
  Postpneumonectomy empyema (PPE) is a possible complication after a pneumonectomy in patients with lung cancer. The use of intrapleural (IP) antibiotic irrigation to treat infections in the pleural space may be indicated after systemic antimicrobial therapy, and drainage of the pleural space has been insufficient.
  
  
  METHODS
  Adult patients ≥18 years old who received IP antibiotic irrigation between 2006 and 2011 were included. Demographic data, past medical history, surgical procedure, systemic antibiotics, and culture data were collected. Additionally, the IP antibiotic administered, the dose, and how it was prepared and administered were collected.
  
  
  RESULTS
  A total of 18 patients were evaluated in this retrospective descriptive analysis. The majority of patients underwent an extrapleural pneumonectomy (EPP; 72%). Most patients received systemic antibiotics before IP antibiotic administration (95%). Vancomycin was the most common antibiotic used for both systemic therapy (100%) and IP irrigation (94%). The median number of IP antibiotic doses received per patient was 5.5 (interquartile range [IQR] 1-9). Recurrence of PPE within 6 months of initial PPE resolution occurred in 28% of patients. Intrapleural antibiotic irrigation was well tolerated in all patients.
  
  
  CONCLUSIONS
  Vancomycin is most commonly used for IP antibiotic irrigation at our institution after patients have undergone a thoracic surgery, which was most commonly an EPP.
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA htorbic@partners.org.
authors.forename: Heather
authors.initials: H
authors.lastname: Torbic
authors.affiliation: Department of Pharmacy, Crozer-Chester Medical Center, Upland, PA, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Glasser
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Rostas
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alquwaizani
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gaspar
authors.initials: G
authors.lastname: Hacobian
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016724:Empyema, Pleural / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods
chemical_list: D000890:Anti-Infective Agents
keywords: critical care; infectious disease; medication safety