Respiratory Care: Chest Infections |

Lung Abscess: Patient Characteristics, Microbiology, and Determinants of Complete Radiographic Resolution as a Treatment Endpoint FREE TO VIEW

Sunkaru Touray, MBChB; Carlos Martinez-Balzano, MD; Jisoo Lee, MD; Emil Tigas, MD; Scott Kopec, MD
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University of Massachusetts Medical School, Worcester, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1237A. doi:10.1016/j.chest.2016.08.1349
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SESSION TITLE: Chest Infections

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Antibiotic therapy remains the mainstay for the treatment of lung abscess, however the optimal duration of remains unknown; and has been variably reported as ranging from 6-8 weeks. Radiographic resolution has been suggested as a valid endpoint for the termination of antibiotic therapy, however there are no studies reporting the time and determinants of radiographic resolution using high resolution CT scans. We present a case series of 56 patients with lung abscess seen at our institution, reporting on patient characteristics, radiographic findings as well as time to complete radiographic resolution.

METHODS: Patients were identified by querying electronic medical records for ICD-10 codes for Gangrene and necrosis of lung (J85.0); Lung abscess with pneumonia (J85.1) and abscess of lung without pneumonia (J85.2) in a 7-year period from January, 2008 to November, 2015. High-resolution CT scans were reviewed and follow up imaging was available for 40 patients from which time to radiologic resolution was reported as the interval between radiologic diagnosis and resolution of abscess cavitation with residual scarring or fibrosis. Abscess size was determined by measurement of the widest diameter of the cavitary lesion on CT scans. Sputum bacteriology isolates are reported for spontaneously and bronchoscopically obtained samples.

RESULTS: Mean age was 57 years, 70 % were male; and 50 % had a positive sputum culture of which 42.9 % were polymicrobial. MSSA and Streptococcus species were the most common isolates, each comprising 25 %, followed by MRSA and Pseudomonas aeruginosa, each comprising 14.3 %. Four patients (7.1 %) had an empyema requring drainage, while six patients (11 %) eventually required surgery due to medical treatment failure. Mean abscess diameter was 58 mm; the most commonly involved lobes were: right upper lobe (32.5 %), left lower lobe (27.5 %) and left upper lobe (20%). The median time to complete radiologic resolution was 16 weeks (IQR: 6.21 - 21). Abscesses < 30mm required 6.3 weeks (IQR: 3 - 14) for resolution, while abscesses between 30 - 60mm required 8.5 weeks (IQR: 6.1 - 18.3). The median time for abscesses >60mm was 16 weeks (IQR: 8.4 - 27.7) and age as well as abscess diameter were positively correlated with time to complete resolution (Pearson’s correlation coefficient = 0.51 and 0.29, respectively).

CONCLUSIONS: Antibiotic treatment duration for the treatment of lung abscess is in the range of 6 - 16 weeks; with age and abscess size being positively correlated with a longer time to radiologic resolution. These, along with other clinical factors, including microbial isolates should be used to individualize timing of surgical or interventional radiological drainage in refractory cases, particularly in abscesses larger than 60mm where the anticipated duration of therapy is prolonged.

CLINICAL IMPLICATIONS: Antibiotic therapy remains the mainstay for the treatment of lung abscesses with success rates of about 89 % in our case series, however older patients with abscesses > 60 mm in size, may require extended treatment courses and surgical or percutaneous drainage for successful treatment.

DISCLOSURE: The following authors have nothing to disclose: Sunkaru Touray, Carlos Martinez-Balzano, Jisoo Lee, Emil Tigas, Scott Kopec

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