title: Survival in Patients With Malignant Pleural Effusions Who Developed Pleural Infection: A Retrospective Case Review From Six UK Centers.
abstract: OBJECTIVE
  Malignant pleural effusion (MPE) incidence is increasing, and prognosis remains poor. Indwelling pleural catheters (IPCs) relieve symptoms but increase the risk of pleural infection. We reviewed cases of pleural infection in patients with IPCs for MPE from six UK centers between January 1, 2005, and January 31, 2014.
  
  
  METHODS
  Survival in patients with pleural infection was compared with 788 patients with MPE (known as the LENT [pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, serum neutrophil to lymphocyte ratio, and tumor type] cohort) and with national statistics.
  
  
  RESULTS
  Of 672 IPCs inserted, 25 (3.7%) became infected. Most patients (20 of 25) had mesothelioma or lung cancer. Median survival in the pleural infection cohort appeared longer than in the LENT cohort, although this result did not achieve significance (386 days vs 132 days; hazard ratio, 0.67; P = .07). Median survival with mesothelioma and pleural infection was twice as long as national estimates for mesothelioma survival (753 days vs < 365 days) and double the median survival of patients with mesothelioma in the LENT cohort (339 days; 95% CI, nonoverlapping). Survival with lung and breast cancer did not differ significantly between the groups. Sixty-one percent of patients experienced early infection. There was no survival difference between patients with early and late infection (P = .6).
  
  
  CONCLUSIONS
  This small series of patients with IPCs for MPE suggests pleural infection may be associated with longer survival, particularly in patients with mesothelioma. Results did not achieve significance, and a larger study is needed to explore this relationship further and investigate whether the local immune response, triggered by infection, is able to modulate mesothelioma progression.
authors.affiliation: Royal United Hospital NHS Trust, Combe Park, Bath.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Bibby
authors.affiliation: North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol.
authors.forename: Amelia O
authors.initials: AO
authors.lastname: Clive
authors.affiliation: Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge; Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge.
authors.forename: Gerry C
authors.initials: GC
authors.lastname: Slade
authors.affiliation: North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Morley
authors.affiliation: Musgrove Park Hospital, Taunton, Somerset.
authors.forename: Janet
authors.initials: J
authors.lastname: Fallon
authors.affiliation: Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxfordshire.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Psallidas
authors.affiliation: Musgrove Park Hospital, Taunton, Somerset.
authors.forename: Justin C T
authors.initials: JCT
authors.lastname: Pepperell
authors.affiliation: Royal United Hospital NHS Trust, Combe Park, Bath.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Slade
authors.affiliation: Great Western Hospital NHS Trust, Swindon, Wiltshire.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Stanton
authors.affiliation: Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxfordshire.
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
authors.affiliation: North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol; Academic Respiratory Unit, University of Bristol School of Clinical Sciences, Bristol, England. Electronic address: Nick.Maskell@bristol.ac.uk.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Maskell
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000401:mortality*; D002404:Catheterization / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010998:Pleurisy / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D006113:United Kingdom