Journal Club March 2022

The bacteriology of pleural infection (TORPIDS): an exploratory metagenomics analysis through next generation sequencing

Kanellakis, NI et al.

The Lancet Microbe,

A hugely impressive body of work from Kanellakis et al using next generation sequencing techniques to examine the pleural fluid from the PILOT study (large observational study of patients with pleural infection). Previous studies have used less patients or more dated techniques.

In a remarkable 79% of samples more than 1 microbe was identified using NGS. That is compared to just 11% of samples using conventional culture methods. As with previous analysis, hospital acquired infections were likely to be polymicrobial, have a predominance of anaerobic bacteria and represented a higher risk of death. However, in contrast to previous analysis the anaerobes and Gram negative bacteria, detected by 16S rRNA NGS, had the highest abundance in community acquired cases.

The authors acknowledge that as NGS techniques become increasingly sensitive identifying the causative agents from innocent bystanders in pleural fluid becomes more difficult. It emphasises that broad spectrum antibiotics are required for all cases even community acquired where an organism is identified by conventional culture.

The priorities of people with mesothelioma and their carers: A qualitative interview study of trial participation and treatment decisions. 

Bibby AC, et l.

Eur J Oncol Nurs.

PMID: 35247743

A qualitative paper looking of 12 semi-structured interviews with 5 patients who took part in a randomised trial of intra-pleural immunotherapy and their relatives. Several interesting themes emerged and probably one of the most important was the value placed on quality of life over quantity and the implications on taking medications and entering trials.

Effect of meteorological factors on first episode and recurrence of primary spontaneous pneumothorax. 

Tülüce K, Sevilgen G.

Rev Assoc Med Bras (1992). 2022 Feb;68(2):165-169. doi: 10.1590/1806-9282.20210821.

PMID: 35239876

A cross disciplinary study looking at the association between climate (i.e., atmospheric pressure, humidity, wind speed, temperature, and precipitation) and the incidence of pneumothorax. Several papers have been published in this area before with variable results. The current paper is too small (n=168) to draw any meaningful conclusions but the area is crying out for a similar analysis using a large dataset e.g. HES.

Fishbone in the pleural space: an unusual case of pleural empyema. 

Nellipudi JA, Seow K, Tharion J.

ANZ J Surg. 2022 Feb 28. doi: 10.1111/ans.17576. Online ahead of print.

PMID: 35229463 No abstract available.

An image paper to finish. The title gives it away somewhat!