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Intrapleural Antimicrobial Irrigation for Postpneumonectomy Empyema in Patients With Lung Cancer

Heather Torbic1, Nicole Glasser2, Sara E Rostas3

  • 1Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA htorbic@partners.org.

Journal of Pharmacy Practice
|August 10, 2014
PubMed
Abstract

Insights

Intrapleural antibiotic irrigation, commonly with vancomycin, is a well-tolerated treatment for postpneumonectomy empyema (PPE) after thoracic surgery. Recurrence of PPE was observed in 28% of patients within six months.

Area of Science:

  • Thoracic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Postpneumonectomy empyema (PPE) is a serious complication following lung cancer surgery.
  • Intrapleural (IP) antibiotic irrigation is considered when systemic therapy and drainage are insufficient.

Purpose of the Study:

  • To evaluate the use and outcomes of IP antibiotic irrigation for treating PPE.
  • To identify common antibiotic agents and treatment protocols.

Main Methods:

  • Retrospective analysis of 18 adult patients who received IP antibiotic irrigation between 2006-2011.
  • Data collected included demographics, surgical history, systemic antibiotics, and IP antibiotic details (agent, dose, preparation).

Main Results:

  • Most patients (72%) underwent extrapleural pneumonectomy (EPP).
  • Vancomycin was the predominant antibiotic for both systemic therapy (100%) and IP irrigation (94%).
  • The median number of IP doses was 5.5, with 28% experiencing PPE recurrence within 6 months. Treatment was well tolerated.

Conclusions:

  • Vancomycin is the most frequently used antibiotic for IP irrigation in PPE management at this institution.
  • IP antibiotic irrigation is a safe and potentially effective adjunct therapy for refractory PPE.
Keywords:
critical careinfectious diseasemedication safety

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