Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection

• Published in: The New England journal of medicine Vol. 365; no. 6; pp. 518 - 526
• Main Authors: Rahman, Najib M, Maskell, Nicholas A, West, Alex, Teoh, Richard, Arnold, Anthony, Mackinlay, Carolyn, Peckham, Daniel, Davies, Robert J.O, Davies, Chris W.H, Davies, Helen E, Ali, Nabeel, Kinnear, William, Bentley, Andrew, Kahan, Brennan C, Wrightson, John M, Hooper, Clare E, Lee, Y.C. Gary, Hedley, Emma L, Crosthwaite, Nicky, Choo, Louise, Helm, Emma J, Gleeson, Fergus V, Nunn, Andrew J
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 11-08-2011
• Subjects: Adult; Aged; Antibiotics; Bacterial infections; Biofilms; Clinical trials; Deoxyribonuclease; Deoxyribonucleases - adverse effects; Deoxyribonucleases - therapeutic use; Deoxyribonucleic acid; DNA; Double-Blind Method; Drug dosages; Effusion; Female; Fibrin; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Hospitals; Humans; Infections; Instillation, Drug; Intention to Treat Analysis; Linear Models; Lung - diagnostic imaging; Male; Middle Aged; Patients; Pleural Diseases - diagnostic imaging; Pleural Diseases - drug therapy; Pleural Diseases - mortality; Pleural Effusion - diagnostic imaging; Pleural Effusion - drug therapy; Radiography; Regulatory approval; Sepsis; Statistical analysis; Surgery; Surgical drains; t-Plasminogen activator; Thoracic surgery; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; United Kingdom > UK; United States > US
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1012740

Slowly clearing infections in the pleural space are a source of substantial morbidity. This study showed that instillation of recombinant DNase and tissue plasminogen activator (t-PA) is more effective than placebo in clearing radiographic pleural effusions.
Pleural infection affects more than 65,000 patients each year in the United States and the United Kingdom,
1
and the incidence is increasing in both countries — in both children
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–
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and adults.
5
,
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The mortality rate from pleural infection is between 10% and 20%,
5
,
7
–
9
and drainage through a chest tube and administration of antibiotics fail in approximately one third of patients, who then require surgical drainage.
5
,
9
The median duration of the hospital stay for these patients is 12 to 15 days,
5
,
6
,
8
,
9
with 25% hospitalized for more than a month. Care of each patient costs . . .