Intrapleural fibrinolytics

Abstract

Pleural space infection (complicated parapneumonic effusion and empyema) is common and causes significant morbidity and mortality of up to 10%. The incidence of community-acquired pneumonia in the United States is estimated at 3.5 to 4 million cases per year with about 20% of patients requiring hospitalization. A parapneumonic effusion develops in approximately half of hospitalized patients with pneumonia, translating into 300,000 to 350,000 parapneumonic effusion annually. Most are small and resolve with antibiotics alone without pleural space sequelae. However, the effusion can progress to a complicated parapneumonic effusion (CPE) or empyema. Management ranges from observation to thoracotomy with decortication. The use intrapleural fibrinolytics, such as streptokinase, urokinase, and tissue plasminogen activator (tPA) to augment chest-tube drainage of a CPE and empyema is widespread; however, case series, cohort studies, and small randomized, controlled trials have conflicting conclusions. © 2007 Springer-Verlag London Limited.