Pleural Infection: What We Need to Know but Don't
Pleural Infection: What We Need to Know but Don't
Purpose of review Pleural infection remains a common and difficult problem to manage in the 21st century. Despite advances in modern healthcare, the rising incidence and mortality of empyema highlights a need for better understanding of the disease and more effective strategies in its diagnosis and treatment.
Recent findings Recent studies have progressed our knowledge and understanding of the bacteriology and pathophysiology of pleural infection. However, rather than providing firm conclusions, examination of current literature provokes several unanswered questions on most aspects of the disease.
Summary This review aims to challenge traditional current concepts and approaches to clinical practice in pleural infection, to stimulate debate and research into potential novel future therapies.
Empyema has remained one of the oldest and most severe respiratory diseases since its first description over 2000 years ago. Potent antimicrobials, better access to primary and tertiary healthcare, improved living conditions and nutritional status of the population, and new vaccines were all previously expected to eliminate pleural infection in the developed world. Not only have these factors failed to eradicate the disease, pleural infection is now reemerging as a growing health threat worldwide.
Pleural infection (complicated parapneumonic effusion and empyema) is rising in incidence across all age groups worldwide, confirmed by studies from the USA, Canada, Europe, and Asia. The mortality rate of empyema has risen alarmingly. In Utah, death rates from empyema were six-fold higher in 2000–2004 compared with 1950–1975. The view among the public and many clinicians that pleural infection is no longer a serious illness is misguided, and must be corrected to heighten awareness of the disease.
Many of the traditional concepts on the pathophysiology and management of pleural infection are not evidence based, and have been accepted for generations without careful scrutiny. Dissection of existing evidence and willingness to challenge 'conventional wisdom' in clinical practice of pleural infection are key requirements to advance the field. This review aims to highlight major shortcomings of current beliefs and approaches to pleural infection to stimulate thoughts, debates, ideas, and hopefully future research.
Abstract and Introduction
Abstract
Purpose of review Pleural infection remains a common and difficult problem to manage in the 21st century. Despite advances in modern healthcare, the rising incidence and mortality of empyema highlights a need for better understanding of the disease and more effective strategies in its diagnosis and treatment.
Recent findings Recent studies have progressed our knowledge and understanding of the bacteriology and pathophysiology of pleural infection. However, rather than providing firm conclusions, examination of current literature provokes several unanswered questions on most aspects of the disease.
Summary This review aims to challenge traditional current concepts and approaches to clinical practice in pleural infection, to stimulate debate and research into potential novel future therapies.
Introduction
Empyema has remained one of the oldest and most severe respiratory diseases since its first description over 2000 years ago. Potent antimicrobials, better access to primary and tertiary healthcare, improved living conditions and nutritional status of the population, and new vaccines were all previously expected to eliminate pleural infection in the developed world. Not only have these factors failed to eradicate the disease, pleural infection is now reemerging as a growing health threat worldwide.
Pleural infection (complicated parapneumonic effusion and empyema) is rising in incidence across all age groups worldwide, confirmed by studies from the USA, Canada, Europe, and Asia. The mortality rate of empyema has risen alarmingly. In Utah, death rates from empyema were six-fold higher in 2000–2004 compared with 1950–1975. The view among the public and many clinicians that pleural infection is no longer a serious illness is misguided, and must be corrected to heighten awareness of the disease.
Many of the traditional concepts on the pathophysiology and management of pleural infection are not evidence based, and have been accepted for generations without careful scrutiny. Dissection of existing evidence and willingness to challenge 'conventional wisdom' in clinical practice of pleural infection are key requirements to advance the field. This review aims to highlight major shortcomings of current beliefs and approaches to pleural infection to stimulate thoughts, debates, ideas, and hopefully future research.