title: Pleural space infections after image-guided percutaneous drainage of infected intraabdominal fluid collections: a retrospective single institution analysis.
abstract: BACKGROUND
  Percutaneous drainage of infected intraabdominal fluid collections is preferred over surgical drainage due to lower morbidity and costs. However, it can be a challenging procedure and catheter insertion carries the potential to contaminate the pleural space from the abdomen. This retrospective analysis demonstrates the clinical and radiographic correlation between percutaneous drainage of infected intraabdominal collections and the development of iatrogenic pleural space infections.
  
  
  METHODS
  A retrospective single institution analysis of 550 consecutive percutaneous drainage procedures for intraabdominal fluid collections was performed over 24 months. Patient charts and imaging were reviewed with regard to pleural space infections that were attributed to percutaneous drain placements. Institutional review board approval was obtained for conduct of the study.
  
  
  RESULTS
  6/550 (1.1%) patients developed iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections. All 6 patients presented with respiratory symptoms and required pleural space drainage (either by needle aspiration or chest tube placement), 2 received intrapleural fibrinolytic therapy and 1 patient had to undergo surgical drainage. Pleural effusion cultures revealed same bacteria in both intraabdominal and pleural fluid in 3 (50%) cases. A video with a dynamic radiographic sequence demonstrating the contamination of the pleural space from percutaneous drainage of an infected intraabdominal collection is included.
  
  
  CONCLUSIONS
  Iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections occur at a low incidence, but the pleural empyema can be progressive requiring prompt chest tube drainage, intrapleural fibrinolytic therapy or even surgery. Expertise in intraabdominal drain placements, awareness and early recognition of this complication is critical to minimize incidence, morbidity and mortality in these patients.
authors.affiliation: Department of Surgery, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA.
authors.forename: Diego M
authors.initials: DM
authors.lastname: Avella
authors.affiliation: Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Toth
authors.affiliation: Department of Surgery, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Reed
authors.affiliation: Department of Surgery, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA.
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.affiliation: Department of Surgery, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Kimchi
authors.affiliation: Department of Radiology, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Dr, Hershey, PA, 17033, USA.
authors.forename: Rickeshvar P
authors.initials: RP
authors.lastname: Mahraj
authors.affiliation: Department of Surgery, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Staveley-O'Carroll
authors.affiliation: Department of Surgery, Pennsylvania State University College of Medicine, 500 University Drive, H070, Hershey, PA, 17033, USA. jkaifi@web.de.
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
mesh_terms: D000293:Adolescent; D000368:Aged; D004322:Drainage / Q000009:adverse effects*; D016724:Empyema, Pleural / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000382:microbiology* / Q000628:therapy*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*