Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study.
<h4>Introduction</h4>Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT).<h4>Methods</h4>...
Guardado en:
| Autores principales: | , , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Public Library of Science (PLoS)
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/30887be71f8b4511958e8c38224f47f6 |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:30887be71f8b4511958e8c38224f47f6 |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:30887be71f8b4511958e8c38224f47f62021-12-02T20:06:11ZIntrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study.1932-620310.1371/journal.pone.0257339https://doaj.org/article/30887be71f8b4511958e8c38224f47f62021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257339https://doaj.org/toc/1932-6203<h4>Introduction</h4>Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT).<h4>Methods</h4>We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Between 2001 and 2010, patients had RTT with intrapleural urokinase (RTT-U). After 2011, patients received intrapleural urokinase and DNase with RTT (RTT-UD). Data were collected through a standardized questionnaire.<h4>Results</h4>One hundred and thirty-three patients were included: 93 were men and the mean age was 59 years (standard deviation 17.2). Eighty-one patients were treated with a combination of intrapleural urokinase and DNase, and 52 were treated with intrapleural urokinase only. In the RTT-UD, RTT failure occurred in 14 patients (17%) compared to 10 (19%) in the RTT-U group (P = 0.82). There was no difference between the two groups in intensive care unit admission, surgical referrals or in-hospital mortality. RTT-UD was associated with faster time to apyrexia (aOR = 0.51, 95%CI [0.37-0.72]), a reduced length of hospital stay (aOR = 0.61, 95%CI [0.52-0.73]) and a higher volume of total pleural fluid retrieved (aOR = 1.38, 95%CI [1.02-1.88]). Complications were rare with only one hemothorax in the RTT-UD group and no pneumothorax requiring drainage in either group.<h4>Conclusion</h4>Compared to urokinase only, intrapleural use of urokinase and DNase in RTT was associated with quicker defervescence, shorter hospital stay and increased volumes of pleural fluid drained. Randomized controlled trials evaluating urokinase and DNase with RTT technique would be required to confirm these results.David Luque PazBetsega BayehPierre ChauvinFlorence PoizeauMathieu LederlinMallorie KerjouanCharles LefevreBertrand de LatourJulien LetheullePierre TattevinStéphane JouneauPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257339 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Medicine R Science Q |
| spellingShingle |
Medicine R Science Q David Luque Paz Betsega Bayeh Pierre Chauvin Florence Poizeau Mathieu Lederlin Mallorie Kerjouan Charles Lefevre Bertrand de Latour Julien Letheulle Pierre Tattevin Stéphane Jouneau Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study. |
| description |
<h4>Introduction</h4>Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT).<h4>Methods</h4>We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Between 2001 and 2010, patients had RTT with intrapleural urokinase (RTT-U). After 2011, patients received intrapleural urokinase and DNase with RTT (RTT-UD). Data were collected through a standardized questionnaire.<h4>Results</h4>One hundred and thirty-three patients were included: 93 were men and the mean age was 59 years (standard deviation 17.2). Eighty-one patients were treated with a combination of intrapleural urokinase and DNase, and 52 were treated with intrapleural urokinase only. In the RTT-UD, RTT failure occurred in 14 patients (17%) compared to 10 (19%) in the RTT-U group (P = 0.82). There was no difference between the two groups in intensive care unit admission, surgical referrals or in-hospital mortality. RTT-UD was associated with faster time to apyrexia (aOR = 0.51, 95%CI [0.37-0.72]), a reduced length of hospital stay (aOR = 0.61, 95%CI [0.52-0.73]) and a higher volume of total pleural fluid retrieved (aOR = 1.38, 95%CI [1.02-1.88]). Complications were rare with only one hemothorax in the RTT-UD group and no pneumothorax requiring drainage in either group.<h4>Conclusion</h4>Compared to urokinase only, intrapleural use of urokinase and DNase in RTT was associated with quicker defervescence, shorter hospital stay and increased volumes of pleural fluid drained. Randomized controlled trials evaluating urokinase and DNase with RTT technique would be required to confirm these results. |
| format |
article |
| author |
David Luque Paz Betsega Bayeh Pierre Chauvin Florence Poizeau Mathieu Lederlin Mallorie Kerjouan Charles Lefevre Bertrand de Latour Julien Letheulle Pierre Tattevin Stéphane Jouneau |
| author_facet |
David Luque Paz Betsega Bayeh Pierre Chauvin Florence Poizeau Mathieu Lederlin Mallorie Kerjouan Charles Lefevre Bertrand de Latour Julien Letheulle Pierre Tattevin Stéphane Jouneau |
| author_sort |
David Luque Paz |
| title |
Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study. |
| title_short |
Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study. |
| title_full |
Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study. |
| title_fullStr |
Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study. |
| title_full_unstemmed |
Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study. |
| title_sort |
intrapleural use of urokinase and dnase in pleural infections managed with repeated thoracentesis: a comparative cohort study. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/30887be71f8b4511958e8c38224f47f6 |
| work_keys_str_mv |
AT davidluquepaz intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT betsegabayeh intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT pierrechauvin intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT florencepoizeau intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT mathieulederlin intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT malloriekerjouan intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT charleslefevre intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT bertranddelatour intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT julienletheulle intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT pierretattevin intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy AT stephanejouneau intrapleuraluseofurokinaseanddnaseinpleuralinfectionsmanagedwithrepeatedthoracentesisacomparativecohortstudy |
| _version_ |
1718375415105454080 |