An international survey on the practice patterns of intrapleural enzymatic therapy for complicated parapneumonic effusions and empyema

Background: Pleural space infection is a common clinical problem in thoracic medicine and is associated with significant morbidity and mortality. Prior studies have described multiple treatment strategies in the management of complicated parapneumonic effusions (CPPEs) and empyema. As a result, significant variation likely exists in clinical practice patterns amongst healthcare providers around the world. Methods: An online survey was distributed to all members of international societies of physicians who manage CPPEs and empyema. The survey evaluated current practice patterns of physicians in the management of CPPEs and empyema, including use of thoracostomy tubes and intrapleural enzymatic therapy (IET). Results: A total of 170 respondents completed the survey. Surveys were completed by an international group of providers: 64 (38 %) of providers practiced in Europe, 36 (21 %) in Asia, 35 (20 %) in North America, 24 (14 %) in Australia, 8 (5 %) in South America, and 3 (2 %) in Africa. The most common primary specialties were Pulmonary Medicine and Interventional Pulmonology. Ten percent of respondents (17/170) did not use IETs in their management of CPPEs and empyema, and the most cited reason was a lack of availability. For the remaining 153 respondents who reported IET use, 86 (56 %) used alteplase, 38 (25 %) used streptokinase, and 25 (16 %) used urokinase in their practices. Conclusions: This survey is the first to provide a descriptive analysis of current international practice patterns and variation in the management of CPPEs and empyema. There is a wide range of practice patterns among physicians. The choice of fibrinolytic, dose, dwell time, and number of days of treatment vary greatly.