Evaluation of the ϵfficacy of medical thoracoscopy in the τreatment of pleural ιnfection

Background : The role of rigid thoracoscopy under local anesthesia in pleural infection is unknown as few studies reported results, none of them prospective and randomized. The aim of our study was to evaluate the efficacy of medical thoracoscopy in comparison to the treatment with pleural drainage in pleural infection. Methods : Between 01/2008 and 08/2013, 63 patients (median age 54, 52 males) with primary non-tuberculous pleural infection were treated in our department. We compared characteristics and outcome of patients with pleural infection, who underwent rigid thoracoscopy under local anesthesia only, versus classic chest tube drainage. Results All 63 patients initially received antibiotic treatment for their infection. 21 patients (18 early and 3 late) underwent thoracoscopy under local anesthesia and 42 chest tube drainage for the treatment of their pleural infection. No significant difference was observed in age, gender, presence of comorbidities, pleural pH, LDH, proteins, serum CRP, or amount of drained fluid between the two groups. Significant difference in favor of thoracoscopy was observed in total days of hospitalization (p=0.01), days of pleural drainage (p=0.02), referral to surgery (p=0.02). A trend towards a worst outcome of patients referred from another hospital was noted overall (p=0.09), but especially in relation to the classic treatment (p=0.06). Conclusion : In this retrospective cohort study medical thoracoscopy provides better results than chest tube drainage in an experienced center of the management of patients with pleural infections. These results should be further confirmed by a prospective randomized study.