An review of infection rates of invasive pleural procedures

Abstract

Introduction We run a well established, safe and streamlined pleural service, serving over 500,000 patients across 3 different sites. We have previously published our low infection and high sensitivity rates of indwelling pleural catheters*IPCs) and thoracoscopy respectively. In January 2015, we stopped giving prophylactic gentamicin prior to such procedures due an adverse event and low infection rates. There are no national guidelines. Methods We have reviewed our infection rates from Jan 2015 to Jan 2016. All our procedures are done aseptically in theatre. Results 28 IPCs were performed, and there were 5 infections (18%), 2 within 4 weeks of the procedure. 1 was an empyema requiring intrapleural fibribolytics (IPFs) and drain removal, 2 supercifical cellulitis and 2 insertion site abscesses, with 1 IPC removed from each group. 40 thoracoscopies were performed, and there were 2 empyemas,(4%) both requiring IPFs. 1 of them was within 4 weeks of procedure. All required admission and 6 required treatment with intravenous antibiotics. Length of stay was between 1 and 36 days. Bacteria grown were Corynebacterium jeikeirum, Streptococcus anginosis and Coagulase negative staphylococcus. There was no associated mortality. Conclusions This is a small sample and our previous data was based on review of 70 IPCs and 173 thoracoscopies. However, we cannot ignore the increasing rate of infections. There is some evidence of giving doxycycline or co-amoxiclav prophylactically, and so we have opted to start giving 2 grams of flucloxacillin pre and post operatively. Further work will determine if that is correct, but we would welcome data from more pleural centres on this topic.