Introduction

Pleural infection is associated with considerable morbidity and mortality, 20 to 30% fail initial treatment with antibiotics and chest drain who may require surgery. MIST 2 trial showed that use of intrapleural t-PA(t-PA) & DNase was effective and safe. It is often used on failure of initial medical management as an adjunct prior to surgery or in patients not fit for surgery. 

Aims and objectives

We reviewed patients with pleural infection who had intrapleural t-PA and Dnase - their outcomes, surgical referral and for any complications in our centre.

Methods

This was a retrospective study, examined data from adult inpatients treated for pleural infection, between 1st January 2018 and 31st December 2020. Inpatient notes and outpatient letters were reviewed and data collated.

Results

83 inpatients were treated for pleural infection between 2018 and 2020. Of these, 18 received intrapleural 10mg Alteplase and 5mg Dnase over 3 days (6 patients in 2018, 5 in 2019 and 7 in 2020).

Average age - 64 years old (33-94). 

61% (n=11) were male and 39% (n=7) were female. 

72.2% (n=13) of patients had an improvement in their imaging, did not require surgery, and discharged. 15.8% (n=3) had cardiothoracic surgery. 11.1% (n=2) did not improve after treatment and were deemed unsuitable for surgery. 

None of our patients had any complications from above treatment.

30-day mortality was 5.6% (n=1)- this patient dying from unrelated causes. 

Conclusions

Intrapleural t-PA and Dnase therapy is an effective tool in the management of pleural infection; experience in our centre showed reduced frequency of surgical referral, no major complications and good outcomes.