Abstract
INTRODUCTION: Intrapleural enzyme therapy (IET) with fibrinolytics and deoxyribonuclease (DNase) is increasingly being added to standard care (SC) for the treatment of pleural infection. METHODS: A systematic literature search of the PubMed and Embase databases was conducted from January 2010 to December 2022 to identify studies reporting treatment response, safety or mortality of IET or SC in pleural infection. RESULTS: 19 studies were included. 12 evaluated treatment response with IET, with a pooled hospital length of stay (LOS) of 12.9 (95% CI 10.4-15.4) days and an average surgery requirement of 11.5% (95% CI 7.2-18.0). In SC, six studies assessed treatment response, with a pooled hospital LOS of 22.7 (95% CI 17.9-27.4) days and a surgery requirement of 23.4% (95% CI 8.3-50.5). The pooled incidence of significant bleeding in the IET group, assessed in 11 studies, was 3.7% (95% CI 2.9-4.5). In-hospital mortality rates were 3.7% (95% CI 1.5-9.1) for IET and 13.7% (95% CI 5.6-29.9) for SC. CONCLUSIONS: IET demonstrated a favourable treatment response and lower mortality rate compared to SC, with an acceptable safety profile.