U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection
Nicholas A. Maskell, M.R.C.P., Christopher W.H. Davies, M.D., Andrew J. Nunn, M.Sc., Emma L. Hedley, Fergus V. Gleeson, F.R.C.P., Robert Miller, F.R.C.P., Rhian Gabe, M.Phil., Glyn L. Rees, Timothy E.A. Peto, F.R.C.P., Mark A. Woodhead, F.R.C.P., Donald J. Lane, F.R.C.P., Janet H. Darbyshire, M.B., Ch.B., Robert J.O. Davies, D.M., for the First Multicenter Intrapleural Sepsis Trial (MIST1) Group
Background Intrapleural fibrinolytic agents are used in thedrainage of infected pleural-fluid collections. This use isbased on small trials that did not have the statistical powerto evaluate accurately important clinical outcomes, includingsafety. We conducted a trial to clarify the therapeutic roleof intrapleural streptokinase.
Methods In this double-blind trial, 454 patients with pleuralinfection (defined by the presence of purulent pleural fluidor pleural fluid with a pH below 7.2 with signs of infectionor by proven bacterial invasion of the pleural space) were randomlyassigned to receive either intrapleural streptokinase (250,000IU twice daily for three days) or placebo. Patients receivedantibiotics and underwent chest-tube drainage, surgery, andother treatment as part of routine care. The number of patientsin the two groups who had died or needed surgical drainage atthree months was compared (the primary end point); secondaryend points were the rates of death and of surgery (analyzedseparately), the radiographic outcome, and the length of thehospital stay.
Conclusions The intrapleural administration of streptokinasedoes not improve mortality, the rate of surgery, or the lengthof the hospital stay among patients with pleural infection.
Source Information
From the Oxford Centre for Respiratory Medicine, Churchill Hospital Site, Oxford Radcliffe Hospital, Headington, Oxford (N.A.M., E.L.H., F.V.G., G.L.R., T.E.A.P., D.J.L., R.J.O.D.); the Department of Respiratory Medicine, Royal Berkshire Hospital, Reading (C.W.H.D.); the Medical Research Council Clinical Trials Unit, London (A.J.N., R.G., J.H.D.); the Department of Population Sciences and Primary Care, University College, London (R.M.); and the Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester (M.A.W.) — all in the United Kingdom.
Address reprint requests to Dr. Davies at the Oxford Centre for Respiratory Medicine, Oxford Radcliffe Hospital, Headington, Oxford OX3 7LJ, United Kingdom, or at robert.davies{at}ndm.ox.ac.uk.
A Trial of Intrapleural Streptokinase
Katikireddy C. K., Dube D. S., Diacon A. H., Koegelenberg C. F.N., Bolliger C. T., Rosa U. W., Bouros D., Davies R. J.O., Maskell N. A., Nunn A. J.
Extract |
Full Text |
PDF
N Engl J Med 2005;
352:2243-2245, May 26, 2005.
Correspondence
This article has been cited by other articles:
Goralski, J. L., Bromberg, P. A., Haithcock, B.
(2009). Intrapleural hemorrhage after administration of tPA: a case report and review of the literature. Ther Adv Respir Dis
3: 295-300
[Abstract]
Heffner, J. E., Klein, J. S., Hampson, C.
(2009). Interventional Management of Pleural Infections. Chest
136: 1148-1159
[Abstract][Full Text]
Komissarov, A. A., Mazar, A. P., Koenig, K., Kurdowska, A. K., Idell, S.
(2009). Regulation of intrapleural fibrinolysis by urokinase-{alpha}-macroglobulin complexes in tetracycline-induced pleural injury in rabbits. Am. J. Physiol. Lung Cell. Mol. Physiol.
297: L568-L577
[Abstract][Full Text]
Chalmers, J D, Singanayagam, A, Murray, M P, Scally, C, Fawzi, A, Hill, A T
(2009). Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax
64: 592-597
[Abstract][Full Text]
Wozniak, C. J., Paull, D. E., Moezzi, J. E., Scott, R. P., Anstadt, M. P., York, V. V., Little, A. G.
(2009). Choice of First Intervention is Related to Outcomes in the Management of Empyema.. Ann. Thorac. Surg.
87: 1525-1531
[Abstract][Full Text]
Emerson, C. R., Bercume, C. M., Antonopoulos, M. S., Marzella, N.
(2009). The Administration of rt-PA (Activase(R)) for the Treatment of Empyema in an Adult Patient. Journal of Pharmacy Practice
22: 117-123
[Abstract]
Sahn, S. A.
(2009). Pleural Disease. ACCP Pulmonary Med Brd Rev
25: 513-546
[Full Text]
Sibley, C. D., Parkins, M. D., Rabin, H. R., Duan, K., Norgaard, J. C., Surette, M. G.
(2008). A polymicrobial perspective of pulmonary infections exposes an enigmatic pathogen in cystic fibrosis patients. Proc. Natl. Acad. Sci. USA
105: 15070-15075
[Abstract][Full Text]
Rahman, N. M., Mishra, E. K., Davies, H. E., Davies, R. J. O., Lee, Y. C. G.
(2008). Clinically Important Factors Influencing the Diagnostic Measurement of Pleural Fluid pH and Glucose. Am. J. Respir. Crit. Care Med.
178: 483-490
[Abstract][Full Text]
Gervais, D. A., Levis, D. A., Hahn, P. F., Uppot, R. N., Arellano, R. S., Mueller, P. R.
(2008). Adjunctive Intrapleural Tissue Plasminogen Activator Administered via Chest Tubes Placed with Imaging Guidance: Effectiveness and Risk for Hemorrhage. Radiology
246: 956-963
[Abstract][Full Text]
Menendez-Gonzalez, M., Oliva-Nacarino, P., Alvarez-Cofino, A.
(2007). Cerebral Gas Embolism Caused by Pleural Fibrinolytic Treatment. Stroke
38: 2602-2604
[Abstract][Full Text]
Chen, C.-H., Hsu, W.-H., Chen, H.-J., Chen, W., Shih, C.-M., Hsia, T.-C., Tu, C.-Y.
(2007). Different Bacteriology and Prognosis of Thoracic Empyemas Between Patients With Chronic and End-Stage Renal Disease. Chest
132: 532-539
[Abstract][Full Text]
Heppler, J. S.
(2007). Intrapleural Fibrinolytics for Pleural Infection: Optimizing Dosing for Future Trials-Reply-I. Mayo Clin Proc.
82: 1016-1016
[Full Text]
Chapman, S. J., Khor, C. C., Vannberg, F. O., Frodsham, A., Walley, A., Maskell, N. A., Davies, C. W. H., Segal, S., Moore, C. E., Gillespie, S. H., Denny, P., Day, N. P., Crook, D. W., Davies, R. J. O., Hill, A. V. S.
(2007). I{kappa}B Genetic Polymorphisms and Invasive Pneumococcal Disease. Am. J. Respir. Crit. Care Med.
176: 181-187
[Abstract][Full Text]
Drain, A. J, Ferguson, J. I, Sayeed, R., Wilkinson, S., Ritchie, A.
(2007). Definitive Management of Advanced Empyema by Two-Window Video-Assisted Surgery. Asian Cardiovasc. Thorac. Ann.
15: 238-239
[Abstract][Full Text]
Deschamps, C.
(2007). Intrapleural Fibrinolytics for Pleural Infection: Partial Answers in the Discussion of Surgical vs Nonsurgical Treatment. Mayo Clin Proc.
82: 405-406
[Full Text]
Levinson, G. M., Pennington, D. W.
(2007). Intrapleural Fibrinolytics Combined With Image-Guided Chest Tube Drainage for Pleural Infection. Mayo Clin Proc.
82: 407-413
[Abstract][Full Text]
Bush, A.
(2007). Update in Pediatric Lung Disease 2006. Am. J. Respir. Crit. Care Med.
175: 532-540
[Full Text]
Farjah, F., Symons, R. G., Krishnadasan, B., Wood, D. E., Flum, D. R.
(2007). Management of pleural space infections: A population-based analysis. J. Thorac. Cardiovasc. Surg.
133: 346-351
[Abstract][Full Text]
Idell, S., Allen, T., Chen, S., Koenig, K., Mazar, A., Azghani, A.
(2007). Intrapleural activation, processing, efficacy, and duration of protection of single-chain urokinase in evolving tetracycline-induced pleural injury in rabbits. Am. J. Physiol. Lung Cell. Mol. Physiol.
292: L25-L32
[Abstract][Full Text]
Treasure, T.
(2006). The evidence on which to base practice: different tools for different times. Eur. J. Cardiothorac. Surg.
30: 819-824
[Full Text]
Horsley, A., Jones, L., White, J., Henry, M.
(2006). Efficacy and Complications of Small-Bore, Wire-Guided Chest Drains. Chest
130: 1857-1863
[Abstract][Full Text]
Tassi, G. F., Davies, R. J. O., Noppen, M.
(2006). Advanced techniques in medical thoracoscopy.. Eur Respir J
28: 1051-1059
[Abstract][Full Text]
Maskell, N. A., Batt, S., Hedley, E. L., Davies, C. W. H., Gillespie, S. H., Davies, R. J. O.
(2006). The Bacteriology of Pleural Infection by Genetic and Standard Methods and Its Mortality Significance. Am. J. Respir. Crit. Care Med.
174: 817-823
[Abstract][Full Text]
Margau, R., Amaral, J. G., Chait, P. G., Cohen, J.
(2006). Percutaneous Thoracic Drainage in Neonates: Catheter Drainage versus Treatment with Aspiration Alone. Radiology
241: 223-227
[Abstract][Full Text]
Lorber, B.
(2006). Update in infectious diseases.. ANN INTERN MED
145: 354-360
[Full Text]
Kurt, B. A., Winterhalter, K. M., Connors, R. H., Betz, B. W., Winters, J. W.
(2006). Therapy of Parapneumonic Effusions in Children: Video-Assisted Thoracoscopic Surgery Versus Conventional Thoracostomy Drainage. Pediatrics
118: e547-e553
[Abstract][Full Text]
Sonnappa, S., Cohen, G., Owens, C. M., van Doorn, C., Cairns, J., Stanojevic, S., Elliott, M. J., Jaffe, A.
(2006). Comparison of Urokinase and Video-assisted Thoracoscopic Surgery for Treatment of Childhood Empyema. Am. J. Respir. Crit. Care Med.
174: 221-227
[Abstract][Full Text]
Zhu, Z., Hawthorne, M. L., Guo, Y., Drake, W., Bilaceroglu, S., Misra, H. L., Light, R. W.
(2006). Tissue Plasminogen Activator Combined With Human Recombinant Deoxyribonuclease Is Effective Therapy for Empyema in a Rabbit Model. Chest
129: 1577-1583
[Abstract][Full Text]
Feller-Kopman, D.
(2006). Ultrasound-Guided Thoracentesis. Chest
129: 1709-1714
[Abstract][Full Text]
Maskell, N., Nunn, A., Davies, R. J O
(2006). Intrapleural streptokinase for pleural infection.. BMJ
332: 552-552
[Full Text]
Tokuda, Y., Matsushima, D., Stein, G. H., Miyagi, S.
(2006). Intrapleural Fibrinolytic Agents for Empyema and Complicated Parapneumonic Effusions: A Meta-analysis. Chest
129: 783-790
[Abstract][Full Text]
Bouros, D., Antoniou, K. M, Light, R. W
(2006). Intrapleural streptokinase for pleural infection. BMJ
332: 133-134
[Full Text]
Light, R. W.
(2006). Parapneumonic effusions and empyema.. Proc Am Thorac Soc
3: 75-80
[Abstract][Full Text]
Cheng, G., Vintch, J. R.E.
(2005). A Retrospective Analysis of the Management of Parapneumonic Empyemas in a County Teaching Facility From 1992 to 2004. Chest
128: 3284-3290
[Abstract][Full Text]
Brutsche, M. H., Tassi, G.-F., Gyorik, S., Gokcimen, M., Renard, C., Marchetti, G. P., Tschopp, J.-M.
(2005). Treatment of Sonographically Stratified Multiloculated Thoracic Empyema by Medical Thoracoscopy. Chest
128: 3303-3309
[Abstract][Full Text]
(2005). ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB. Evid. Based Med.
10: 156-156
[Full Text]
Misthos, P., Sepsas, E., Konstantinou, M., Athanassiadi, K., Skottis, I., Lioulias, A.
(2005). Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur. J. Cardiothorac. Surg.
28: 599-603
[Abstract][Full Text]
Trow, T. K.
(2005). Clinical Year in Review II: Pulmonary Infections, Diagnostic Imaging, Pleural Diseases, and Neuromuscular Disease. Proc Am Thorac Soc
2: 175-178
[Full Text]
Menon, M
(2005). Intrapleural streptokinase does not improve outcomes in empyema. Thorax
60: 450-450
[Full Text]
Katikireddy, C. K., Dube, D. S., Diacon, A. H., Koegelenberg, C. F.N., Bolliger, C. T., Rosa, U. W., Bouros, D., Davies, R. J.O., Maskell, N. A., Nunn, A. J.
(2005). A Trial of Intrapleural Streptokinase. NEJM
352: 2243-2245
[Full Text]
A correction has been published: N Engl J Med 2005;352(20):2146.
Previous
