Fluid Agitation Microbiologic Yield In Pleural Infection Feasibility Study

Alexandria University30 enrolled

Overview

The goal of this study is to compare the microbiologic diagnostic yield of pre-aspiration agitated pleural fluid versus that of conventionally aspirated fluid in pleural infection patients. The main question it aims to answer is, whether fluid agitation helps to increase the microbiological yield.

In pleural infection, It is suggested that the bacteria being diagnostically targeted, might more likely be residing on the pleural surface with a better blood supply and nutrition rather than being planktonic in the acidic, glucose deficient pleural fluid. The investigators thus hypothesize that an agitation of the pleural fluid prior to sample aspiration would aid in achieving a better cellular representation of the pleural space. This could have the effect of washing bacterial cells off the pleural surface as well as moving sedimented cells in the aspirated sample. This study aims to investigate whether an increase in the microbiological yield for infected pleural fluid could be achieved by a pre-aspiration agitation of the pleural fluid which would have a positive effect on management and eventual patient outcomes. Adult participants with pleural infection will undergo thoracentesis via both the standard and agitated fluid techniques guided by thoracic ultrasound. Microbiological yields will be compared.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Pleural Infection

Interventions

Agitated Pleural Fluid ThoracentesisPROCEDURE

Using a 16-18 gauge cannula, a standard thoracentesis will be performed then a sample of pleural fluid will be aspirated and rapidly flushed into the pleural space and redrawn again for a few cycles before a sample is finally drawn into the collection syringe

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age \>18 years old 2. Pleural infection based on clinical presentation, imaging or laboratory investigations and pleural fluid examination showing glucose \< 40 mg/dL or pH \<7.2 with lower respiratory infection or pus on aspiration 3. At least a moderate amount of pleural fluid collection (2 or more intercostal spaces on thoracic ultrasound) Exclusion Criteria: 1. Minimal - mild pleural fluid deemed unsuitable for aspiration and agitation 2. Hemodynamic instability 3. Uncorrected coagulopathy 4. Transudative or exudative lymphocytic pleural effusion on biochemical analysis

Locations (1)

Chest Diseases Department, Alexandria University Faculty of Medicine

Alexandria, Egypt

Outcomes

Primary Outcomes

Diagnostic yield of the microbiologic analysis

Percentage of samples with a positive microbiologic result among both aspiration techniques

Time frame: results within 1 week of sampling