CHEST Guidelines-Pleural-Biopsy-to-Capture-Causative-Microbe

Pleural-Biopsy-to-Capture-Causative-Microbe_chest

Pdf Summary

Pleural infection presents significant clinical challenges worldwide, primarily managed through drainage and antibiotics. Despite historical stagnation, recent advancements have improved treatment outcomes. A pivotal study published in 2000 introduced intrapleural deoxyribonuclease/fibrinolytic therapy, reducing the necessity for surgical drainage. However, advancements in antibacterial strategies lag, partly due to the insufficient data on pleural bacteria and their antibiotic pharmacokinetics. Traditional sampling of pleural fluid often yields low bacterial detection, complicating diagnosis and treatment.<br /><br />The AUDIO study, discussed in this CHEST issue, highlights ultrasound-guided pleural tissue biopsy's potential. This method significantly increases bacterial detection compared to pleural fluid or blood cultures, revealing causative organisms in 45% of cases, which is 2.5 to 4.5 times more effective than fluid or blood specimens, respectively. It also unveiled organisms in 25% of cases where other methods failed.<br /><br />Identification of the infection's causative organisms enables better antibiotic choices, crucial as about 50% of pleural infections remain organism-negative, leading to reliance on broad-spectrum antibiotics. Furthermore, this addresses misconceptions about all pleural infections arising from lung bacteria migration, as not all pleural infections show accompanying pneumonia on imaging. Pleural biopsy, analogous to its use in undiagnosed pleural diseases, could become routine in suspected infections, aiding in organism identification and guiding therapy.<br /><br />The study calls for validation in larger cohorts and across different organism types, emphasizing the need for optimized biopsy techniques and processing. It suggests including pleural biopsy during chest drain insertion to improve diagnosis. This approach may unravel the role of bacteria within the pleura, potentially leading to innovative therapeutic strategies. As understanding of pleural infection complexity grows, capturing causative organisms remains a vital step in solving this clinical puzzle.

Keywords

pleural infection

drainage

antibiotics

intrapleural therapy

ultrasound-guided biopsy

bacterial detection

antibiotic pharmacokinetics

AUDIO study

broad-spectrum antibiotics

diagnostic advancements