Chest
Volume 111, Issue 2, February 1997, Pages 275-279
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Controlled Trial of Intrapleural Streptokinase in the Treatment of Pleural Empyema and Complicated Parapneumonic Effusions

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Objective

To compare the efficacy of adjunctive intrapleural streptokinase (SK) with simple closed chest tube drainage (Drain) in the treatment of empyemas and complicated parapneumonic effusions.

Method

This was a controlled study of 52 patients (mean age, 57 years; 41 men) with pleura space sepsis. Forty patients (77%) had empyema and 12 had complicated parapneumonic effusions. Twenty-nine patients were treated with Drain only while 23 received, in addition, repeated daily SK, 250,000 U in saline solution (mean, 5.3 days).

Results

The two groups of patients had comparable degrees of peripheral blood leukocytosis, frequency of loculated effusions, pleural fluid pH, and lactate dehydrogenase levels. Infective organisms were isolated in 54% of which 32% were anaerobic and 21% were polymicrobial infections. The incidence of surgical decortication was 17% and mortality was 15%. A significantly larger volume of pleural fluid was drained from patients in the SK treatment group (2.0 [1.5] L) than those in the Drain treatment group (1.0 [1.01] L). There were no significant differences, however, between the two treatment groups in terms of duration before defervescence, duration of hospital stay, the need for surgical intervention, or mortality rates.

Conclusion

We conclude that thrombolytic therapy increased the volume of fluid drained from pleural empyemas but did not markedly reduce morbidity and mortality.

Section snippets

Materials and Methods

This was a 5-year (1990 to 1995), prospective study of 52 consecutive patients admitted to the hospital with community-acquired empyema and complicated (high-risk) parapneumonic effusions.17 Empyema (40 patients) was defined according to one or more of the following criteria; (1) grossly purulent fluid; (2) positive fluid culture; and (3) positive Gram stain for bacteria.1 Complicated parapneumonic effusions (12 patients) were defined according to Light1 viz (1) pH <7.00 or (2) lactate

Results

There were 52 patients (41 men and 11 women) with a mean (SD) age of 57 (17) years, range between 16 and 18 years. Most patients (75%) had some underlying disease, with diabetes in 41% and chronic lung diseases in 31%. There were no significant differences in age, sex ratio, frequency of underlying disease, and degrees of peripheral blood leukocytosis between patients on the SK and Drain treatment protocols (Table 1).

Forty patients (77%) had frank empyema and the rest had complicated

Discussion

Previous reports on the use of intrapleural thrombolysis as an adjunctive modality in the treatment of empyema suggested that it may be highly effective with success rates ranging from about 50 to 100%.8, 9, 10, 11, 12, 13, 14, 15, 16 These include a multicenter report of 30 patients from Mexico by Jerjes-Sanchez et al16 (SK was used) and a large series of 84 patients with multiloculated effusions from Denver described by Moulton et al15 (urokinase was used). The overall success rate of 70% (SK

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