Introduction Indwelling pleural catheters (IPCs) are an alternative method for controlling recurrent, symptomatic malignant pleural effusions, currently reserved for cases of known trapped lung, or after an initial unsuccessful talc pleurodesis.1 A 2.8% pleural infection rate has been observed in patients with an IPC2 leading to the concern that this risk of infection may increase further with systemic chemotherapy.
Determine whether systemic chemotherapy increased the number of IPC related pleural infections.
Whether the risk was related to the interval between chemotherapy and IPC insertion.
Methods A detailed retrospective review was performed of the first 100 patients treated with an IPC from February 2011 to December 2013 at Queen Alexandra Hospital, Portsmouth.
Results 11 of the 100 IPC insertions developed pleural infection (11%), four of whom had received chemotherapy (see table). Overall 15 patients received chemotherapy after IPC insertion with an interval varying from 0 days (same day) to 43 days, with a median of 9 days. The 2 × 2 table compared the proportion of patients developing pleural infection with and without chemotherapy.
Further analyses assessed the interval from chemotherapy to IPC insertion and whether it influenced the numbers of pleural infections, using cut-off points at 7, 14, 21 and 28 days. There was no significant difference at any of these time-points (p=NS).
Conclusions The pleural infection rate with an IPC was slightly higher than previous published series. There was however no significant increase in pleural infection in those receiving chemotherapy, although these analyses did not account for variability in tumour type, tumour stage, performance, co-morbidity and leucopenia at time of insertion. While the analyses were not significant, this needs to be retested in larger or combined registries of patients treated with IPCs for pleural malignancy.
Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65
Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70–76
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