Management of patients with pleural infection in Greece: results of the ongoing PRACTICE (PleuRAlInfeCTIon in GreeCE) study

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Introduction: The healthcare-associated burden of pleural infection remains high due to the increasing incidence of the disease, which is characterized by prolonged(10–12 days)hospitalization and significant mortality(10%). Purpose: To record the characteristics, diagnostic approach, treatment and outcome of patients with pleural infection. Method: Multicenter study of patients with pleural infection hospitalized from May 2022 to July 2024. Results: The study included 162 patients(median age:62 years), usually complaining of fever(72%)and chest pain(69%). Radiological findings included pleural effusion not exceeding half of the hemithorax(63%) and loculations(63%). Purulent fluid was found in 25% while pH<7.20,glucose <60 mg/dl or positive culture was observed in 71%,63% and 28% respectively. Isolated bacteria were streptococci(48%), staphylococcus spp(22%) and anaerobes(17%). Chest tube was placed in 92%,41% received intrapleural fibrinolytics while 7 patients were treated without drainage. Initial antibiotics included piperacillin/tazobactam(44%), linezolid(43%) and quinolone(24%). Factors associated with worse prognosis were the size of pleural effusion exceeding the 75% of the hemithorax and the absence of loculations on the initial ultrasound. Median length of hospitalization was 12(IQR:9-17)days and 3-month mortality was 10%. Conclusion: Most patients had moderate pleural effusion with loculations. Seven patients were treated without chest tube placement. The size of pleural effusion exceeding the 75% of the hemithorax and the absence of loculations on the initial ultrasound were associated with worse prognosis. Hospitalization and mortality were similar to historical data.

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