-
Annals of Translational Medicine Aug 2015Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial... (Review)
Review
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most common condition predisposing to lung abscesses. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. In the current review we will present all current information from diagnosis to treatment.
PubMed: 26366400
DOI: 10.3978/j.issn.2305-5839.2015.07.08 -
Ugeskrift For Laeger May 2021A lung abscess is a necrotising infection leading to loss of healthy lung tissue. It develops over several weeks, and the typical presentation includes cough, fever, and... (Review)
Review
A lung abscess is a necrotising infection leading to loss of healthy lung tissue. It develops over several weeks, and the typical presentation includes cough, fever, and general deterioration. The clinical work-up includes contrast-enhanced CT-scans, and frequently flexible bronchoscopy with broncho-alveolar lavage as described in this review. The infection commonly represents aspiration of oral bacterial flora, including anaerobic microbes. Penicillin resistance is common. A lung abscess generally requires long-term, tailored antibiotic treatment. The patient should consult a dentist to identify possible dental foci.
Topics: Anti-Bacterial Agents; Bacteria; Bronchoscopy; Humans; Lung; Lung Abscess
PubMed: 34060466
DOI: No ID Found -
Critical Care (London, England) Oct 2023Patients undergoing mechanical ventilation (MV) for COVID-19 exhibit an increased risk of ventilator-associated pneumonia (VAP). The occurrence of lung abscesses... (Observational Study)
Observational Study
BACKGROUND
Patients undergoing mechanical ventilation (MV) for COVID-19 exhibit an increased risk of ventilator-associated pneumonia (VAP). The occurrence of lung abscesses following VAP in these patients has been poorly studied. We aimed to describe the incidence, characteristics, risk factors and prognosis of lung abscesses complicating VAP after COVID-19.
METHODS
We conducted an observational, retrospective study in three French intensive care units. Patients admitted for acute respiratory failure with a confirmed SARS-CoV-2 PCR and requiring MV for more than 48 h were included.
RESULTS
Among the 507 patients included, 326 (64%) had a documented VAP. Of these, 23 (7%) developed a lung abscess. Enterobacterales (15/23, 65%) were the main documentation, followed by non-fermenting Gram-negative bacilli (10/23, 43%) and Gram-positive cocci (8/23, 35%). Lung abscesses were mainly plurimicrobial (15/23, 65%). In multivariate analysis, a plurimicrobial 1st VAP episode (OR (95% CI) 2.93 (1.16-7.51); p = 0.02) and the use of hydrocortisone (OR (95% CI) 4.86 (1.95-12.1); p = 0.001) were associated with lung abscess development. Intensive care unit (ICU) mortality of patients with lung abscesses reached 52%, but was not significantly higher than for patients with VAP but no lung abscess. Patients with lung abscesses had reduced ventilator-free days at day 60, a longer duration of MV and ICU stay than patients with VAP but no lung abscess (respectively, 0 (0-3) vs. 16 (0-42) days; p < 0.001, 49 (32-73) vs. 25 (11-41) days; p < 0.001, 52 (36-77) vs. 28 (16-47) days; p < 0.001).
CONCLUSIONS
Lung abscessing pneumonia is not uncommon among COVID-19 patients developing VAP. A plurimicrobial first VAP episode and the use of hydrocortisone are independently associated with this complication. In COVID-19 patients with persistent VAP, a chest CT scan investigating the evolution toward lung abscess should be considered.
Topics: Humans; Pneumonia, Ventilator-Associated; Lung Abscess; Retrospective Studies; Cohort Studies; Hydrocortisone; COVID-19; SARS-CoV-2; Respiration, Artificial; Intensive Care Units
PubMed: 37794402
DOI: 10.1186/s13054-023-04660-x -
Archives of Iranian Medicine Jun 2022
Topics: Actinomyces; Empyema, Pleural; Humans; Lung Abscess
PubMed: 35943021
DOI: 10.34172/aim.2022.65 -
Lung Abscess and Pyothorax in Critically Ill COVID-19 Patients: A Single-Center Retrospective Study.Critical Care Explorations May 2023The mortality rate of patients with COVID-19 pneumonia requiring mechanical ventilation remains high. This study determined the percentage and characteristics of...
The mortality rate of patients with COVID-19 pneumonia requiring mechanical ventilation remains high. This study determined the percentage and characteristics of patients who developed lung abscesses or pyothorax and their mortality rates among adult patients with COVID-19 admitted to the ICU who required mechanical ventilation. Of the 64 patients with COVID-19 assessed, 30 (47%) developed ventilator-associated pneumonia (VAP), of whom 6 (20%) developed pyothorax or lung abscess. There were no statistically significant differences in patient characteristics, treatment after ICU admission, or outcomes between those with and without these complications, except for age. VAP complicated by Lung abscess or pyothorax was caused by a single organism, with = 4) and species ( = 2) being the primary causative agents. Occur infrequently in patients with COVID-19 requiring mechanical ventilation. Large-scale studies are required to elucidate their effects on clinical outcomes.
PubMed: 37197587
DOI: 10.1097/CCE.0000000000000919 -
Respiratory Medicine Sep 2023Lung abscess (LA) is a serious respiratory infection often followed by several weeks of antibiotic treatment. This study described the clinical presentation of LA,...
INTRODUCTION
Lung abscess (LA) is a serious respiratory infection often followed by several weeks of antibiotic treatment. This study described the clinical presentation of LA, treatment duration and mortality in a contemporary Danish population.
METHODS
In a retrospective multicenter cohort study at four Danish hospitals, patients diagnosed with LA were identified using the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) between 2016 and 2021. A predefined data collection tool was used to extract data on demographics, symptoms, clinical findings and treatment.
RESULTS
Of 302 patients, 222 with LA were included after review of patient records (76%). Mean age was 65 years (54-74), 62.9% was male and 74.9% were ever-smokers. Chronic obstructive pulmonary disease (COPD) (35.1%), use of sedatives (29.3%) and alcohol abuse (21.8%) were common risk factors. Dental status was reported in 51.4%, whereof 41.6% had poor dental status. Patients presented with cough (78.8%), malaise (61.3%) and fever (56.8%) Patients were hospitalized for a median of 14 days (interquartile ranges, IQR 7-21) and median duration of antibiotic treatment was 38 days (IQR 30-51). All-cause mortality after 1, 3 and 12 months was 2.7%, 7.7% and 15.8%, respectively.
CONCLUSION
Risk factors for LA include COPD and use of sedatives, alcohol abuse, and poor dental status. Despite long-term antibiotic treatment, long-term mortality is markedly high.
Topics: Humans; Male; Aged; Lung Abscess; Cohort Studies; Disease Progression; Alcoholism; Pulmonary Disease, Chronic Obstructive; Anti-Bacterial Agents; Denmark
PubMed: 37302422
DOI: 10.1016/j.rmed.2023.107305 -
Children (Basel, Switzerland) Jul 2022(1) Background: Lung abscess is a lung infection that leads to the destruction of the lung parenchyma, resulting in a cavity formation and central necrosis filled with...
(1) Background: Lung abscess is a lung infection that leads to the destruction of the lung parenchyma, resulting in a cavity formation and central necrosis filled with purulent fluids. It is an uncommon pediatric problem, and there is a paucity of literature reviews on this subject, especially for the pediatric age group. Lung abscess is commonly divided into those considered primary in previously well children or secondary in those with predisposing co-morbidities. The predominant pathogens isolated from primary lung abscesses are the aerobic organisms, including streptococcal species, Staphylococcus aureus, and Klebsiella pneumoniae, while anaerobic bacteria such as Bacteroides species are predominant in secondary groups. Children usually present with fever, cough, shortness of breath, chest pain, and sputum. While physical examination may reveal diffuse crackles on auscultation, the diagnosis is usually confirmed by chest X-ray. (2) Methods: We report four different cases with lung abscesses from both primary and secondary group with similar presentations and radiological findings, but the approach was different in each according to the underlining cause. (3) Conclusions: Conservative therapies with a prolonged course of antibiotics remain the cornerstone of therapy for both primary and secondary lung abscesses. The underlying cause should be considered when there is a suboptimal response. However, invasive intervention is becoming more popular with better yield, shorter duration of antibiotics and admission, and excellent prognosis.
PubMed: 35884031
DOI: 10.3390/children9071047 -
Cureus Nov 2022A 72-year-old male presented to the ER with three days of productive cough, shortness of breath, and generalized weakness. Chest X-ray showed right lung opacity in the...
A 72-year-old male presented to the ER with three days of productive cough, shortness of breath, and generalized weakness. Chest X-ray showed right lung opacity in the lower lobe. Chest CT scan showed consolidation in the superior segment of the right lower cavity with air-fluid level extending to the pleural and chest wall, suggestive of lung abscess with loculated empyema and thickened pleura. The patient received antibiotics and CT-guided aspiration of blood-tinged fluid followed by two weeks of drainage via a transthoracic catheter. There was a near-complete resolution of the opacity and closure of the lung abscess on follow-up chest imaging. The patient clinically improved with resolution of the cough and dyspnea. Workup was negative for bacteria and acid-fast bacilli (AFB). The purpose of this paper is to review short-term and long-term management, approach, and consideration to be taken while facing a pan-negative etiological workup of a complicated abscess.
PubMed: 36579261
DOI: 10.7759/cureus.31910 -
International Journal of Surgery Case... Aug 2022Early thoracic empyema is usually treated through video-assisted thoracoscopic (VATS) decortication. Patient selection is important for decortication if an effective...
INTRODUCTION
Early thoracic empyema is usually treated through video-assisted thoracoscopic (VATS) decortication. Patient selection is important for decortication if an effective surgical outcome is required. Lung isolation techniques are required to provide anesthesia for these patients to facilitate the surgeon while operating on the affected lung. The ultimate target is to protect the non-diseased contra-lateral lung from contamination.
PRESENTATION OF CASE
We are presenting a unique case of 20-year-old female, resident of Karachi, who was brought to the emergency room (ER) with signs of sepsis, hypotension, and multi-organ failure. She was brought to the operating room to undergo video-assisted thoracoscopy (VATS) for lung abscess decortication when her medical therapy had failed. On table decision of right upper lobe resection was made and ventilation strategy had to be modified accordingly.
DISCUSSION
The main anaesthetic aim was to protect the healthy parts of the lung from the abscess. Regular suctioning of secretions during surgery via the double lumen tube (DLT) lumen on the diseased side is recommended. While performing VATS, the lung abscess got ruptured and immediate measures to isolate the lung was taken to assist with surgical resection of the affected lobe. Lobectomy can only be done once the lung was completely isolated and maintaining perfusion and ventilation of the relatively healthy lung help in managing hypoxia.
CONCLUSION
Peri-operative management of ruptured lung abscesses required thorough pre-op evaluation, intraoperative lung isolation and ventilation, and postoperative analgesia with combined team effort both surgical and anaesthetic, are vital fundamentals to consider in guaranteeing the best outcome.
PubMed: 35868131
DOI: 10.1016/j.ijscr.2022.107381