title: Management of Intrapleural Sepsis with Once Daily Use of Tissue Plasminogen Activator and Deoxyribonuclease.
abstract: BACKGROUND
  Pleural infection remains a significant cause of morbidity, mortality, prolonged hospital stay, and increased healthcare costs, despite advances in therapy. Twice daily intrapleural tissue plasminogen activator (tPA)/deoxyribonuclease (DNase) initiated at the time of diagnosis has been shown to significantly improve radiological outcomes and decrease the need for surgery.
  
  
  OBJECTIVE
  To analyze our experience with once daily tPA/DNase for intrapleural sepsis.
  
  
  METHODS
  Data derived from consecutive patients with empyema and complicated parapneumonic effusion who received once daily intrapleural tPA/DNase between January 2012 and August 2014 were reviewed. Measured outcomes included treatment success at 30 days, volume of pleural fluid drained, improvement in radiographic pleural opacity, length of hospital stay, need for surgery, and adverse events.
  
  
  RESULTS
  55 consecutive patients (33 male; mean age ± SD, 54.6 ± 16.1 years) were treated with once daily intrapleural tPA/DNase for 3 days. The majority of the patients (n = 51; 92.7%) were successfully managed without the need for surgical intervention. The mean change in pleural opacity measured on chest radiograph at day 7 was -28.8 ±17.6%. The median amount of fluid drained was 2,195 ml. No serious adverse events requiring discontinuation of intrapleural medications were observed. The most common complication was pain requiring escalating doses of analgesics (n = 8; 15%). Compliance with the protocol was excellent.
  
  
  CONCLUSIONS
  Early administration of once daily intrapleural tPA/DNase for 3 days is safe, effective, and represents a viable option for the management of empyema and complicated parapneumonic effusion.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, Fla., USA.
authors.forename: Hiren J
authors.initials: HJ
authors.lastname: Mehta
authors.forename: Abhishek
authors.initials: A
authors.lastname: Biswas
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Penley
authors.forename: Jessica
authors.initials: J
authors.lastname: Cope
authors.forename: Matthew
authors.initials: M
authors.lastname: Barnes
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jantz
mesh_terms: D000328:Adult; D000368:Aged; D003851:Deoxyribonucleases / Q000008:administration & dosage*; D004322:Drainage; D004359:Drug Therapy, Combination; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D003851:Deoxyribonucleases; D010959:Tissue Plasminogen Activator