ABSTRACT
Background: Pleural infection has a considerable healthcare burden with an average hospital stay of 14 days. There have been no randomised trials on the use of therapeutic thoracentesis (TT) for initial pleural fluid drainage. Aim(s): To assess the feasibility of a full-scale trial of chest tube vs TT for pleural infection. The primary outcome was defined as the acceptability of randomisation (ad priori defined as successful if >=50% of eligible patients were randomised). Method(s): Adult patients admitted with a pleural effusion related to infection and meeting recognised criteria for drainage were eligible. Participants were randomised (unblinded) to chest tube insertion or TT. Patients were followed up at 90 days. Result(s): From September 2019 and June 2021, 51 patients were diagnosed with complex parapneumonic effusion/empyema. Eleven patients met the inclusion criteria for trial and 10 patients were randomised (91%). The COVID-19 pandemic had a significant impact on recruitment. Patients randomised to TT had a shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p=0.04. Total number of pleural procedures required per patient were similar, 1.2 in chest tube group and 1.4 in TT group. No patients required surgical referral. Adverse events were similar between the groups with no readmissions related to pleural infection. Data completeness was high with no protocol deviations. Conclusion(s): The ACTion trial met its prespecified feasibility criteria for patient acceptability. The suggestion that TT can reduce hospital length of stay requires further investigation.
ABSTRACT
Methicillin-resistant Staphylococcus aureus (MRSA) infections are a primary health concern. They are commonly differentiated as hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, based on their epidemiology, susceptibility findings, and molecular typing patterns. Therefore, appropriate contact precautions and isolation measures should be implemented. CA-MRSA mostly causes skin and soft-tissue infections, but the probability and incidence of it causing sepsis and invasive infections have increased dramatically in recent years. In this study, we report a case of CA-MRSA pneumonia with pan-pneumonic effusion in a 59-year-old male diabetic patient with preexisting comorbidities such as diabetic ketoacidosis and non-ST elevated myocardial infarction. The early reporting of the organism's identity and its antimicrobial susceptibility, as well as timely initiation of antibiotic therapy, aided in the successful management and cure of the patient.
ABSTRACT
Background: Air - leak syndrome is one of the dreaded complication in COVID -19 viral pneumonia. It has been described in severe cases during acute COVID -19 Infection. Spontaneous pneumothorax after mild COVID-19 disease has been rarely reported. Methods: A retrospective descriptive study was conducted in SDS TRC AND RGICD, Bangalore. All patients presenting to our hospital from May 2021 to October 2021 with air -leak syndrome with a prior history of COVID -19 infection were included. Details obtained from the medical records included the demographics, radiology, laboratory investigations and outcome. Results: 24 patients presented with air- leak syndrome. Median age was 54 years with male predominance (84%). 33% had severe COVID disease, 29% had moderate and 37% were mild COVID cases. Median duration of presentation with air -leak syndrome from covid-19 infection was 29 days (Range- 8-90). 58% had Hydro-pneumothorax and 41% had pneumothorax. Pleural fluid analysis was suggestive of para-pneumonic effusion in 11cases while three had tubercular hydro-pneumothorax. Mean duration of ICD in-situ was 24days . Chest radiography showed consolidation in 21 patients and 3 patients had no consolidation, pneumatocele was observed in 2 patients . one patient developed BPF, 3 patients succumbed and the rest were discharged. Conclusion: Air-leak syndrome is a life threatening complication of COVID-19 infection which can manifest even after a mild disease and with out NIV use . Multiple factors lead to development of air -leak syndrome. Prompt recognition of the same is crucial to avoid mortality.