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Updated: Jan 9, 2026
03:22
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
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Managing treatment failure in pleural infection.
Malvika Bhatnagar1, Rebecca Burney2, Eihab O Bedawi3
1Pleural Diseases, Oxford Respiratory Trials Unit, Oxford, UK.
Expert Review of Respiratory Medicine
|December 3, 2025
Summary
Treatment failure in pleural infection is common. Early diagnosis and precision medicine integrating various data can improve patient outcomes and guide treatment escalation.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pleural infection presents significant morbidity and mortality.
- Over one-third of patients experience treatment failure with initial management.
- Treatment failure necessitates advanced therapies like intrapleural enzyme therapy (IET) or surgery.
Purpose of the Study:
- To review advances in the diagnosis and management of treatment failure in pleural infection.
- To examine current and emerging treatment strategies.
- To highlight the importance of early identification and precision medicine.
Main Methods:
- Comprehensive literature search of PubMed, Embase, and Cochrane Library (January 2005-April 2025).
- Keywords included pleural infection, diagnostics, biomarkers, and treatment interventions.
- Analysis of multifactorial causes of treatment failure and review of therapeutic options.
Main Results:
- Treatment failure is multifactorial, involving delayed presentation, pleural fluid barriers (viscosity, septation, thickening, biofilm), host factors, and microbial complexity.
- Current strategies include antibiotics, chest tube drainage, IET (tPA+DNase), and surgery.
- Emerging modalities include next-generation sequencing, pleural biopsy, medical thoracoscopy, saline irrigation, and indwelling catheters.
Conclusions:
- Early identification of treatment failure (within 48 hours) is critical for escalating care.
- A precision medicine approach integrating microbiological, radiological, and host-response data is essential.
- Future priorities include risk stratification, biomarker-guided therapy, microbiome-informed antibiotics, and improved global access to treatment.
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