Background and Objectives: The management of infectious pleural diseases varies widely worldwide. This study evaluates preliminary data from the global INTERMITTENT cohort (N=158) to map its epidemiology, microbiology, and therapeutic strategies across different geographical macro-areas. Materials and Methods: Data were stratified by country and analyzed using Chi-square and Fisher's exact tests (p<0.05). Results: The cohort (mostly European, from Pulmonology/Internal Medicine departments) was primarily linked to community-acquired pneumonia, with hypertension (43.4%) and diabetes (26.6%) as main comorbidities. Pleural culture positivity was 27.9%, showing significant geographical variation (p=0.041): Streptococcus species dominated in Europe, whereas Klebsiella pneumoniae prevailed in Asia and North Africa. Chest drain insertion and thoracentesis were the cornerstone interventions (p=0.249). Intrapleural enzyme therapy (IET) revealed a highly significant polarization (p=0.002): sequential tPA/DNase combination was standard in the UK, Denmark, Portugal, and Hong Kong, while Urokinase or Streptokinase mono-therapy prevailed in Spain and Egypt. Overall 12-week mortality (10.7%) and readmission rates (11.4%) did not significantly correlate with the specific pleural procedures performed (p>0.05). However, hospital length of stay varied significantly across countries (p=0.013), with markedly prolonged stays in the UK and Portugal. Conclusions: Preliminary findings confirm high clinical complexity and significant geographical heterogeneity in real-world pleural infection management, highlighting the value of completing global recruitment to foster more uniform international guidelines.
Background e Obiettivi: La gestione delle pleuriti infettive mostra un'elevata eterogeneità internazionale. Questo studio analizza i dati preliminari della coorte globale INTERMITTENT (N=158) per mapparne l'epidemiologia, la microbiologia e le strategie terapeutiche tra diverse macroaree geografiche. Materiali e Metodi: I dati sono stati stratificati per nazionalità e analizzati mediante test del Chi-quadrato e test esatto di Fisher (p<0,05). Risultati: La coorte (prevalentemente europea, da reparti di Pneumologia/Medicina Interna) è associata a polmoniti comunitarie, con ipertensione (43,4%) e diabete (26,6%) come comorbidità principali. La positività colturale pleurica è del 27,9%, con variazioni geografiche significative (p=0,041): il genere Streptococcus domina in Europa, mentre Klebsiella pneumoniae prevale in Asia e Nord Africa. Il drenaggio pleurico e la toracentesi rimangono i capisaldi interventistici (p=0,249). La terapia enzimatica (IET) mostra una polarizzazione netta (p=0,002): combinazione tPA/DNAsi in UK, Danimarca, Portogallo e Hong Kong; Urokinasi o Streptokinasi esclusive in Spagna ed Egitto. Mortalità a 12 settimane (10,7%) e riammissioni (11,4%) non correlano significativamente con il tipo di procedura pleurica eseguita (p>0,05), mentre la durata del ricovero varia significativamente tra i paesi (p=0,013), con degenze più lunghe in UK e Portogallo. Conclusioni: I risultati preliminari confermano la complessità e la forte variabilità geografica nella gestione real-world delle infezioni pleuriche, sottolineando la necessità di completare il progetto per promuovere linee guida internazionali più uniformi.
Eziologia e gestione clinica delle pleuriti infettive: risultati preliminari da uno studio internazionale multicentrico (the INTERMITTENT study)
LUCCHETTI, BENEDETTA
2025/2026
Abstract
Background and Objectives: The management of infectious pleural diseases varies widely worldwide. This study evaluates preliminary data from the global INTERMITTENT cohort (N=158) to map its epidemiology, microbiology, and therapeutic strategies across different geographical macro-areas. Materials and Methods: Data were stratified by country and analyzed using Chi-square and Fisher's exact tests (p<0.05). Results: The cohort (mostly European, from Pulmonology/Internal Medicine departments) was primarily linked to community-acquired pneumonia, with hypertension (43.4%) and diabetes (26.6%) as main comorbidities. Pleural culture positivity was 27.9%, showing significant geographical variation (p=0.041): Streptococcus species dominated in Europe, whereas Klebsiella pneumoniae prevailed in Asia and North Africa. Chest drain insertion and thoracentesis were the cornerstone interventions (p=0.249). Intrapleural enzyme therapy (IET) revealed a highly significant polarization (p=0.002): sequential tPA/DNase combination was standard in the UK, Denmark, Portugal, and Hong Kong, while Urokinase or Streptokinase mono-therapy prevailed in Spain and Egypt. Overall 12-week mortality (10.7%) and readmission rates (11.4%) did not significantly correlate with the specific pleural procedures performed (p>0.05). However, hospital length of stay varied significantly across countries (p=0.013), with markedly prolonged stays in the UK and Portugal. Conclusions: Preliminary findings confirm high clinical complexity and significant geographical heterogeneity in real-world pleural infection management, highlighting the value of completing global recruitment to foster more uniform international guidelines.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/26797