Pulmonary Self-Study Resources-Bedawi ERS.ESTS statement on the management of pleural infection in adults Eur Respir J 2023

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The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) collaborated to update clinical guidelines for managing pleural infection in adults, combining expertise from multiple disciplines and regions. The statement highlights several key areas in the management of pleural infections:<br /><br />1. **Epidemiology:**<br />   - The incidence of pleural infections is rising globally, driven by factors such as an aging population, increased use of immunosuppressive medications, and improved imaging techniques.<br />   - Comorbidities like diabetes, respiratory and cardiovascular diseases are significant risk factors.<br /><br />2. **Antibiotic Therapy:**<br />   - Prompt, focused antibiotic therapy is crucial to combat pleural infections, with adjustments based on microbiological results and local resistance patterns.<br />   - Despite low pleural fluid culture yields, empirical antibiotic coverage often includes broad-spectrum and anaerobic agents.<br />   - Initial therapy typically involves 5-7 days of intravenous antibiotics, followed by oral therapy based on clinical response.<br /><br />3. **Diagnostic Parameters:**<br />   - Pleural fluid analysis (pH < 7.2, low glucose, high LDH) remains vital for diagnosing pleural infections and guiding chest tube drainage decisions.<br />   - Imaging, primarily ultrasound and CT, is used to assess the extent of effusion and guide interventions.<br /><br />4. **Interventions:**<br />   - Small-bore chest drains (12-14 F) placed under image guidance are effective for primary drainage.<br />   - Intrapleural Enzyme Therapy (IET) combining tissue plasminogen activator (tPA) with DNase is supported by robust evidence (notably from the MIST-2 study). IET should be considered early if initial treatment with chest tube drainage and antibiotics fails.<br />   - For patients unresponsive to medical therapy, early surgical referral is advised, with Video-Assisted Thoracoscopic Surgery (VATS) being preferred due to favorable outcomes and reduced morbidity compared to open surgery.<br /><br />5. **Outcome Prediction:**<br />   - The RAPID score is validated for predicting mortality and guiding therapy intensity in pleural infections, emphasizing early and targeted treatment approaches.<br /><br />Key recommendations include routine early interventions, optimal antibiotic use, and stratified treatment based on severity and response to initial therapies. Further research is suggested to refine treatment strategies and improve patient outcomes.

Meta Tag

Asset Type PDF

Curriculum Category Pleural Disease

Curriculum Subcategory Diagnostic and therapeutic procedures

Keywords

pleural infection

ERS

ESTS

clinical guidelines

antibiotic therapy

pleural fluid analysis

intrapleural enzyme therapy