Journal
EXPERT REVIEW OF RESPIRATORY MEDICINE
Volume 13, Issue 4, Pages 337-347Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/17476348.2019.1578212
Keywords
Pleural infection; microbiology; bacteriology; etiology; pathogenesis; antibiotics
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Funding
- Medical Research Council [G1001128] Funding Source: researchfish
- MRC [G1001128] Funding Source: UKRI
- National Institutes of Health Research (NIHR) [PB-PG-0416-20020] Funding Source: National Institutes of Health Research (NIHR)
- Medical Research Council [G1001128] Funding Source: Medline
- Department of Health [PB-PG-0416-20020] Funding Source: Medline
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Introduction: Pleural infection is a condition that continues to pose a significant challenge to respiratory physicians. We hypothesize that the main barriers to progress include limited understanding of the etiopathogenesis, microbiology,and role of antibiotics in the pleural space. Areas covered: PubMed was searched for articles related to adult pleural infection using the terms 'pleural infection', 'empyema' and 'parapneumonic'. The search focused on relevant literature within the last 10 years, with any older citations used only to display context or lack of progress. Tuberculous pleural infection was excluded. We chose to give specific attention to the etiopathogenesis of pleural infection, including recent advances in diagnostics and biomarkers. We discuss our understanding of the pleural microbiome and rationalize the current use of antibiotics in treating this condition. Expert commentary: Understanding of key events in the development of this condition remains limited. The microbiology is unique compared to the lung, and highly variable. Higher culture yields from pleural biopsy may add new insights into the etiopathogenesis. There is little evidence into achievable effective antibiotic concentration within the pleura. Research into issues including the relevance of biofilm formation and significance of pleural thickening is necessary for treatment progress.
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