Infections Associated With Tunnelled Indwelling Pleural Catheters in Patients Undergoing Chemotherapy Essam Mekhaiel, MD, Rahul Kashyap, MBBS, MD, John J. Mullon, MD, and Fabien Maldonado, MD Background: Malignant pleural effusions are common complications of advanced malignancies and are asso- ciated with significant morbidity and reduced survival. Tunnelled indwelling pleural catheters (TIPCs) are implantable devices used for palliation of symptomatic malignant pleural effusions. Although complication rates are overall low, their use in the setting of con- current chemotherapy has not been carefully reviewed. We report our experience with infectious complications directly attributable to TIPCs (pleural or local soft tissue infections) in those patients receiving concurrent chemotherapy. Methods: We conducted a retrospective analysis of patients who underwent TIPC placement for malignant pleural effusion in a 6-year period from November 2005 to March 2011. We reviewed the incidence of infection in these patients receiving catheter placement and attempted to determine whether chemotherapy was associated with an increased infectious risk. Results: A total of 262 TIPC procedures, performed in 243 patients, were included in the study. Out of 262, 173 (66%) TIPC were in the chemotherapy group and 89 TIPC were in the nonchemotherapy group. Infec- tions developed in 16 of the 262 TIPC placements (6.1%). The rate of complications in the chemotherapy group was 9 of the 173 TIPCs (5.2%) compared with 7 of the 89 TIPCs (7.9%) in the other group, a difference that was not statistically different (P = 0.4). Conclusions: The overall risk of infection in TIPC is low. Patients undergoing chemotherapy while the TIPC is in place do not seem to have an increased risk of infection, and therefore chemotherapy should not necessarily be viewed as a contraindication to TIPC insertion. Key Words: pleural effusion, indwelling pleural catheter, chemotherapy, infections (J Bronchol Intervent Pulmonol 2013;20:299–303) M alignant pleural effusions are common complications of advanced malignancies and are associated with significant morbidity and compromised quality of life. They constitute a marker of advanced disease, with a median survival after diagnosis ranging from 3 to 12 months. 1–7 Given this limited survival, treatment should aim at relieving symptoms and improving function while minimizing the need for hospitalization. The optimal strategy remains controversial and the choice of treatment may be dictated by several factors including symptoms and performance status of the patient, primary tumor cell type, and possibility of lung reex- pansion after pleural fluid evacuation. The least invasive option consists of repeated thor- acenteses, but their effect is usually of short duration and therefore most appropriate for frail or terminally ill patients with limited survival expectancy. 8–10 Other options include talc pleu- rodesis (via talc slurry administered using a chest tube or talc insufflation by thoracoscopy), or indwelling pleural catheters. Although both interventions appear equivalent in terms of symptom control, the long-term complication rate, specifically with regards to infectious complications, may be higher with tunnelled indwelling pleural catheters (TIPCs). 10–13 In addition, the presence of an indwelling pleural catheter is often considered a relative contra- indication to chemotherapy owing to a perceived risk of increased infections in this context. Although this may not be supported by existing data, the immunosuppressive effects of chemo- therapy are well recognized, and practice with regards to TIPC placement in these patients varies widely. To clarify this point, we sought to evaluate the incidence of TIPC-related infections in patients who underwent chemotherapy com- pared with those who did not. Received for publication May 18, 2013; accepted August 7, 2013. From the Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Supported by grants from the Department of Pulmonary and Critical Care Medicine at Mayo Clinic, Rochester, MN. Disclosure: There is no confllict of interest or other disclosures. Reprints: Fabien Maldonado, MD, Department of Pulmonary and Critical Care Medicine, Gonda 18, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (e-mail: maldonado.fabien@mayo.edu). Copyright r 2013 by Lippincott Williams & Wilkins ORIGINAL INVESTIGATION J Bronchol Intervent Pulmonol  Volume 20, Number 4, October 2013 www.bronchology.com | 299