title: Pleural infection: past, present, and future directions.
abstract: Pleural space infections are increasing in incidence and continue to have high associated morbidity, mortality, and need for invasive treatments such as thoracic surgery. The mechanisms of progression from a non-infected, pneumonia-related effusion to a confirmed pleural infection have been well described in the scientific literature, but the route by which pathogenic organisms access the pleural space is poorly understood. Data suggests that not all pleural infections can be related to lung parenchymal infection. Studies examining the microbiological profile of pleural infection inform antibiotic choice and can help to delineate the source and pathogenesis of infection. The development of radiological methods and use of clinical indices to predict which patients with pleural infection will have a poor outcome, as well as inform patient selection for more invasive treatments, is particularly important. Randomised clinical trial and case series data have shown that the combination of an intrapleural tissue plasminogen activator and deoxyribonuclease therapy can potentially improve outcomes, but the use of this treatment as compared with surgical options has not been precisely defined, particularly in terms of when and in which patients it should be used.
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Corcoran
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
authors.forename: John M
authors.initials: JM
authors.lastname: Wrightson
authors.affiliation: Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Belcher
authors.affiliation: Division of Thoracic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. Electronic address: najib.rahman@ndm.ox.ac.uk.
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
mesh_terms: D000328:Adult; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D004195:Disease Models, Animal; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005544:Forecasting; D006801:Humans; D009181:Mycoses / Q000188:drug therapy; D010995:Pleural Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013300:Streptokinase / Q000627:therapeutic use; D020775:Thoracic Surgery, Video-Assisted / Q000639:trends; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D005343:Fibrinolytic Agents; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator