A Multicenter Analysis of Factors Predicting Treatment Success for Intrapleural Enzyme Therapy for Pleural Infection

Area of Science:

• Pulmonology
• Infectious Diseases
• Critical Care Medicine

Background:

• Pleural infection, a serious condition, requires multifaceted management including antibiotics, drainage, and potentially intrapleural enzymatic therapy (IET).
• Factors influencing the success of IET for pleural infection are not well understood.
• This study aimed to identify predictors of IET success in patients with pleural infection.

Purpose of the Study:

• To identify factors associated with treatment outcomes in patients receiving intrapleural enzymatic therapy (IET) for pleural infection.
• To determine if the source of infection (community-acquired vs. hospital-acquired) impacts IET success.

Main Methods:

• Retrospective analysis of 185 patients who received IET for pleural infection between January 2018 and May 2024.
• Inclusion criteria: age >18, complicated parapneumonic effusion/empyema, pre- and post-IET CT scans, and clinical/radiological assessment for treatment success.
• Volumetric analysis of CT scans and multivariable logistic regression were used to identify predictive factors.

Main Results:

• A community source of infection was significantly associated with treatment success.
• Hospital-acquired infection was linked to a 71% increased risk of treatment failure (OR: 0.287, P = 0.006).
• Streptococcus species was the most common pathogen identified in pleural cultures.

Conclusions:

• A community source of infection is a strong predictor of successful intrapleural enzymatic therapy for pleural infection.
• Distinguishing between community-acquired and hospital-acquired pleural infections is crucial for predicting treatment response to IET.