Focus
È utile l’urokinasi intrapleurica nel trattamento dell’empiema? Una risposta da una esperienza concreta
IS INTRAPLEURAL UROKINASE EFFECTIVE IN THE TREATMENT OF EMPYEMA?
L. Bogdanovits, E. Barbi, F. Marchetti, N. Giurici, L. Ronfani, A. Ventura
Febbraio 2007 - pagg. 89 -102
Abstract
The use of intrapleural fibrynolisis in the treatment of empyema shortens hospital stay and
is recommended by international guidelines in children with a B grade of evidence. Even
though only few randomized studies have addressed this issue in limited series of patients
with conflicting results. One trial for urokinase showed a positive result while another trial
with streptokinase did not show a significant reduction in length of hospital stay. We retrospectively
rewied a 30 year experience in a third level university hospital comparing length
of treatment in a group of children treated with simple drainage and a group treated with
urokinase. Even if such a retrospective analysis is limited by possible biases which are highlighted
and discussed a significant reduction in length of hospital stay was found without side effects.
Classificazione MeSH
Bibliografia
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3. Rees JH, Spencer DA, Parikh D, Weller P. Increase in incidence of childhood empyema in West Midlands, UK. Lancet 1997;349: 402.
4. Playfor SD, Smyth AR, Stewart RJ. Increase in incidence of childhood empyema. Thorax 1997;52:932.
5. Byington CL, Spencer LY, Johnson TA, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis 2002;34:434-40.
6. Grewal H, Jackson RJ, Wagner CW, Smith SD. Early video-assisted thoracic surgery in the management of empyema. Pediatrics 1999;103:e63.
7. Jaffe A, Cohen G. Thoracic empyema. Arch Dis Child 2003;88:839-41.
8. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med 2006;174(2):221-7.
9. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infections in children. Thorax 2005;60 Suppl 1:i1-21.
10. Tillett WS, Sherry S. The effect in patients of streptococcal fibrinolysin (streptokinase) and streptococcal desoxyribonuclease on fibrinous, purulent, and sanguineous pleural exudations. J Clin Invest 1949;28:173-90.
11. Bergh NP, Ekroth R, Larsson S, Nagy P. Intrapleural streptokinase in the treatment of haemothorax and empyema. Scand J Thorac Cardiovasc Surg 1977;11:265-8.
12. Tuncozgur B, Ustunsoy H, Sivrikoz MC, et al. Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial. Int J Clin Pract 2001; 55:658-60.
13. Diacon AH, Theron J, Schuurmans MM, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respire Crit Care Med 2004; 170:49-53
14. Maskell NA, Davies CWH, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-74.
15. Tan TQ, Mason EO Jr, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics 2002;110:1-6.
16. File TM Jr. Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia. Clin Microbiol Infect 2006;12 Suppl 3:31-41.
17. Marchese A, Gualco L, Cochetti I, et al. Antibiotic susceptibility and serotype distribution in Streptococcus pneumoniae circulating in Italy: results of the SEMPRE surveillance study (2000-2002). Int J Antimicrob Agents 2005;26:138-45.
18. Schultz KD, Fan LL, Pinsky J, et al. The chancing face of pleural empyemas in children: epidemiology and management. Pediatrics 2004;113:1735-40.
19. Byington CL, Samore MH, Stoddard GJ, et al. Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis 2005;41(1):21-9.
20. Byington CL, Korgenski K, Daly J, et al. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J 2006;25(3): 250-4.
21. Calbo E, Diaz A, Canadell E, et al. Spanish Pneumococcal Infection Study Network. Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine. Clin Microbiol Infect 2006;12 (9):867-72.
22. Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynnn IM. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002;57:343-7.
23. Tommasoni N, Stefanutti G, Ghirardo V, Guglielmi M, Gamba PG. Urokinase reduces the need for surgical treatment in pleural empyema. Ital J Pediatr 2003;29:206-10.
24. Krishnan S, Amin N, Dozor AJ, Stringer G. Urokinase in the management of complicated parapneumonic effusions in children. Chest 1997;112:1579-83.
25. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg 1997; 32:1473-5.
26. de Benedictis FM, De Giorgi G, Niccoli A, Troiani S, Rizzo F, Lemmi A. Treatment of complicated pleural effusions with intracavitary urokinase in children. Pediatr Pulmonol 2000;29:438-42.
27. Kilic N, Celebi S, Gurpinar A, et al. Management of thoracic empyema in children. Pediatr Surg Int 2002;18:21-3.
28. Barbato A, Panizzolo C, Monciotti C, Marcucci F, Stefanutti G, Gamba PG. Use of urokinase in childhood with pleural empyema. Pediatr Pulmonol 2003;35:50-5.
29. Yao CT, Wu JM, Liu CC, et al. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest 2004;125:566-71.
30. Barnes NP, Hull J, Thomson AH. Medical management of parapneumonic pleural disease. Pediatr Pulmonol 2005;39:127-34.
31. Singh M, Mathew JL, Chandra S, Katariya S, Kumar L. Randomised controlled trial of intrapleural streptokinase empyema thoracic in children. Acta Paediatr 2004;93: 1443-5.
32. Lahorra JM, Haaga JR, Stellato T, Flanigan T, Graham R. Safety of intracavity urokinase with percutaneous abscess drainage. AJR 1993;160:171-4.
33. Godley PJ, Bell RC. Major hemorrage following administration of intrapleural streptokinase. Chest 1984;86:486-7.
2. Hardie W, Bokulic R, Garcia VF, Reising SF, Christie CD. Pneumococcal pleural empyemas in children. Clin Infect Dis 1996; 22:1057-63.
3. Rees JH, Spencer DA, Parikh D, Weller P. Increase in incidence of childhood empyema in West Midlands, UK. Lancet 1997;349: 402.
4. Playfor SD, Smyth AR, Stewart RJ. Increase in incidence of childhood empyema. Thorax 1997;52:932.
5. Byington CL, Spencer LY, Johnson TA, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis 2002;34:434-40.
6. Grewal H, Jackson RJ, Wagner CW, Smith SD. Early video-assisted thoracic surgery in the management of empyema. Pediatrics 1999;103:e63.
7. Jaffe A, Cohen G. Thoracic empyema. Arch Dis Child 2003;88:839-41.
8. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med 2006;174(2):221-7.
9. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infections in children. Thorax 2005;60 Suppl 1:i1-21.
10. Tillett WS, Sherry S. The effect in patients of streptococcal fibrinolysin (streptokinase) and streptococcal desoxyribonuclease on fibrinous, purulent, and sanguineous pleural exudations. J Clin Invest 1949;28:173-90.
11. Bergh NP, Ekroth R, Larsson S, Nagy P. Intrapleural streptokinase in the treatment of haemothorax and empyema. Scand J Thorac Cardiovasc Surg 1977;11:265-8.
12. Tuncozgur B, Ustunsoy H, Sivrikoz MC, et al. Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial. Int J Clin Pract 2001; 55:658-60.
13. Diacon AH, Theron J, Schuurmans MM, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respire Crit Care Med 2004; 170:49-53
14. Maskell NA, Davies CWH, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-74.
15. Tan TQ, Mason EO Jr, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics 2002;110:1-6.
16. File TM Jr. Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia. Clin Microbiol Infect 2006;12 Suppl 3:31-41.
17. Marchese A, Gualco L, Cochetti I, et al. Antibiotic susceptibility and serotype distribution in Streptococcus pneumoniae circulating in Italy: results of the SEMPRE surveillance study (2000-2002). Int J Antimicrob Agents 2005;26:138-45.
18. Schultz KD, Fan LL, Pinsky J, et al. The chancing face of pleural empyemas in children: epidemiology and management. Pediatrics 2004;113:1735-40.
19. Byington CL, Samore MH, Stoddard GJ, et al. Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis 2005;41(1):21-9.
20. Byington CL, Korgenski K, Daly J, et al. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J 2006;25(3): 250-4.
21. Calbo E, Diaz A, Canadell E, et al. Spanish Pneumococcal Infection Study Network. Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine. Clin Microbiol Infect 2006;12 (9):867-72.
22. Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynnn IM. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002;57:343-7.
23. Tommasoni N, Stefanutti G, Ghirardo V, Guglielmi M, Gamba PG. Urokinase reduces the need for surgical treatment in pleural empyema. Ital J Pediatr 2003;29:206-10.
24. Krishnan S, Amin N, Dozor AJ, Stringer G. Urokinase in the management of complicated parapneumonic effusions in children. Chest 1997;112:1579-83.
25. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg 1997; 32:1473-5.
26. de Benedictis FM, De Giorgi G, Niccoli A, Troiani S, Rizzo F, Lemmi A. Treatment of complicated pleural effusions with intracavitary urokinase in children. Pediatr Pulmonol 2000;29:438-42.
27. Kilic N, Celebi S, Gurpinar A, et al. Management of thoracic empyema in children. Pediatr Surg Int 2002;18:21-3.
28. Barbato A, Panizzolo C, Monciotti C, Marcucci F, Stefanutti G, Gamba PG. Use of urokinase in childhood with pleural empyema. Pediatr Pulmonol 2003;35:50-5.
29. Yao CT, Wu JM, Liu CC, et al. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest 2004;125:566-71.
30. Barnes NP, Hull J, Thomson AH. Medical management of parapneumonic pleural disease. Pediatr Pulmonol 2005;39:127-34.
31. Singh M, Mathew JL, Chandra S, Katariya S, Kumar L. Randomised controlled trial of intrapleural streptokinase empyema thoracic in children. Acta Paediatr 2004;93: 1443-5.
32. Lahorra JM, Haaga JR, Stellato T, Flanigan T, Graham R. Safety of intracavity urokinase with percutaneous abscess drainage. AJR 1993;160:171-4.
33. Godley PJ, Bell RC. Major hemorrage following administration of intrapleural streptokinase. Chest 1984;86:486-7.
Corrispondenza: ebarbi@libero.it