Pleural Infection—a Growing Problem in the Elderly

Abstract

Pleural infection is a common cause of hospitalisation and associated with high morbidity and mortality. This review summarises our current knowledge and practice in cases of pleural infection, with a particular focus on the evidence relevant to the management of this condition in older adults. The incidence of pleural infection is rising in older adults, who often present with less specific symptoms and commonly suffer from one or more comorbidities that can both confound diagnosis and impact on longer-term outcomes. Aspiration of oropharyngeal contents plays an important role in the pathogenesis of pleural infection in older adults which needs to be taken into consideration when deciding on management strategies including antibiotic selection. Treatment focuses on improving the patient’s general condition, appropriate antibiotic therapy and adequate drainage of the infected pleural collection. In cases of failure of initial medical treatment, intrapleural fibrinolytics and surgical debridement of the pleural space are the two main options. Despite the fact that advanced age is a risk factor for poor outcome from pleural infection, older patients are less likely to be referred for definitive surgical treatment in these circumstances. However, the current evidence base does not necessarily show a significantly worse post-operative course in older patients undergoing surgical treatment for pleural infection in comparison to younger adults. Pleural infection is an increasingly common and frequently under-recognised pathology. Timely diagnosis and treatment can have a positive impact on morbidity and mortality, but further research is needed to allow a better understanding of how different or more aggressive treatment strategies might influence the outcome in an elderly and more vulnerable population.