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Baker JB, Balu AR, Rajeswaran S, Patel SJ, Goldstein SD, Donaldson JS. Percutaneous Drainage of Pediatric Pulmonary Abscesses: An Effective Therapy. J Pediatr Surg 2024:S0022-3468(24)00301-4. [PMID: 38834410 DOI: 10.1016/j.jpedsurg.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Pulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula. However, drain placement has been frequently employed at our institution. The purpose of this study was to review and describe our longitudinal experience. METHODS Medical records of children diagnosed with lung abscess and treated with percutaneous drainage from 2005 through 2023 were reviewed. Patient clinical parameters, follow-up imaging, and clinical outcomes were evaluated. RESULTS Percutaneous drainage (n = 24) or aspiration alone (n = 4) under imaging guidance was performed by interventional radiologists for 28 children with lung abscesses. A single catheter (8-12 Fr) was deployed in the pulmonary abscess cavity and remained for a median of 6 days (IQR: 6-8 days). The median hospital stay was 10 days (IQR: 8.8-14.8 days). The technical success rate for percutaneous drainage or aspiration of primary pulmonary abscesses was 100% (26/26). Two children were later diagnosed with secondarily infected congenital pulmonary airway malformations that were both successfully drained and ultimately surgically resected. The abscess cavities resolved in all patients and catheters were removed upon clinical, radiographic, and laboratory improvement. Complications included the presence of two bronchopleural fistula, both of which were treated with immediate pleural drain placement. CONCLUSION Percutaneous drainage of pulmonary abscesses is an effective therapeutic option in children and can be considered alongside antibiotics as part of the initial treatment for pulmonary abscesses. Bronchopleural fistula can occur, but at a lower frequency than previously reported. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Joe B Baker
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Abhinav R Balu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Sameer J Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Seth D Goldstein
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - James S Donaldson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Siji AA, Sajikumar K, Chawla K, Magazine R, Kv R. Lung abscess by Streptococcus intermedius: An unusual first case report from India. Indian J Med Microbiol 2024; 48:100522. [PMID: 38141828 DOI: 10.1016/j.ijmmb.2023.100522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
A unique case report, probably first case from India, of lung abscess caused by Streptococcus intermedius in a previously untreated patient with Type 2 diabetes mellitus is reported here. The patient presented with non-productive cough and right-sided chest pain. Microbiological evaluation confirmed the presence of Streptococcus intermedius and the patient responded positively to antibiotic therapy. This case highlights the fact that S.intermedius may act as pathogen in immunocompromised individuals. So, a caution is needed by the medical fraternity before disregarding it as a commensal.
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Affiliation(s)
- Alfa A Siji
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Keerthana Sajikumar
- Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Rahul Magazine
- Department of Pulmonary Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Rajagopal Kv
- Department of Radiodiagnosis, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
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Montméat V, Bonny V, Urbina T, Missri L, Baudel JL, Retbi A, Penaud V, Voiriot G, Cohen Y, De Prost N, Guidet B, Maury E, Ait-Oufella H, Joffre J. Epidemiology and Clinical Patterns of Lung Abscesses in ICU: A French Multicenter Retrospective Study. Chest 2024; 165:48-57. [PMID: 37652296 DOI: 10.1016/j.chest.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses. RESEARCH QUESTION What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICU, and what are the risk factors of in-ICU mortality? STUDY DESIGN AND METHODS This was a retrospective observational multicenter study, based on International Classification of Diseases, 10th Revision, codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression. RESULTS We analyzed 171 ICU patients with pulmonary abscesses. Seventy-eight percent were male, with a mean age of 56.5 ± 16.4 years; 20.4% misused alcohol, 25.2% had a chronic lung disease (14% COPD), and 20.5% had a history of cancer. Overall, 40.9% were immunocompromised and 38% qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%), and dyspnea (47.4%). Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, Staphylococcus aureus in 22%, and Pseudomonas aeruginosa in 19.3%. Fungal infections were found in 10.5%. Several clusters of clinicoradiologic patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. Percutaneous abscess drainage was performed in 11.7%; surgery was performed in 12.7%, and 12% required bronchial artery embolization for hemoptysis. In-ICU mortality was 21.5%, and age (OR: 1.05 [1.02-1.91], P = .007], renal replacement therapy during ICU stay (OR, 3.56 [1.24-10.57], P = .019), and fungal infection (OR, 9.12 [2.69-34.5], P = .0006) were independent predictors of mortality after multivariate logistic regression, and drainage or surgery were not. INTERPRETATION Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection, with a high proportion of Enterobacteriaceae, S aureus, and P aeruginosa. Percutaneous drainage, surgery, or arterial embolization was required in more than one-third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.
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Affiliation(s)
- Vinca Montméat
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Vincent Bonny
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Tomas Urbina
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Louai Missri
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Jean-Luc Baudel
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Aurélia Retbi
- Département d'Information Médicale, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Victor Penaud
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France
| | - Yves Cohen
- Intensive Care Unit, Avicennes Hospital, APHP, University Sorbonne Paris Nord, Bobigny, France
| | - Nicolas De Prost
- Intensive Care Unit, Henri Mondor University Hospital, APHP, Paris-est Créteil -val de marne University, Créteil, France
| | - Bertrand Guidet
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France; Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Sorbonne University, Paris, France
| | - Eric Maury
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France; 8 Paris Cardiovascular Research Center, Inserm U970, Paris University, Paris, France
| | - Jérémie Joffre
- Intensive Care Unit, Saint-Antoine University Hospital, APHP, Sorbonne University, Paris, France; Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France.
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Lung Abscess Case Series and Review of the Literature. CHILDREN 2022; 9:children9071047. [PMID: 35884031 PMCID: PMC9317617 DOI: 10.3390/children9071047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
(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.
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Baldes N, Bölükbas S. Entzündliche und infektiöse Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen. Zentralbl Chir 2022; 147:287-298. [DOI: 10.1055/a-1720-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEntzündliche Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen umfassen ein weites Spektrum von der komplizierten Pneumonie, der Tuberkulose, Mykosen bis hin zur Echinokokkose.
Die Häufigkeit hängt stark von der geografischen Herkunft ab. Diese Übersichtsarbeit gibt einen Überblick von der Diagnostik bis hin zur chirurgischen Therapie dieser Erkrankungen beim
pädiatrischen Kollektiv.
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Affiliation(s)
- Natalie Baldes
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
| | - Servet Bölükbas
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
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6
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Rai E, Alaraimi R, Al Aamri I. Pediatric lower respiratory tract infection: Considerations for the anesthesiologist. Paediatr Anaesth 2022; 32:181-190. [PMID: 34927318 DOI: 10.1111/pan.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Neonatal and childhood infectious diseases continue to be a global health problem. Acute respiratory tract infections are typically classified as upper respiratory tract infection and lower respiratory tract infections. The most common lower respiratory infections in childhood are pneumonia and bronchiolitis. Vaccination against measles, diphtheria, pertussis, Haemophilus influenzae, pneumococcus, and influenza resulted in a significant reduction in the incidence of acute respiratory tract infection globally. Though the global burden of the disease has decreased, the mortality rates still are higher in developing countries. Patients with severe lower respiratory tract infections and their complications are often evaluated for elective or emergency procedures. In this review article, the authors aim to discuss the etiology, pathogenesis, preoperative evaluation of lower respiratory tract infections, and the anesthesia implications pertinent to the practice of anesthesia.
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Affiliation(s)
- Ekta Rai
- Christian Medical College, Vellore, India
| | - Rashid Alaraimi
- Emergency Physician & Neurocritical Care Fellow, Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | - Is'haq Al Aamri
- Adult and Pediatric Cardiac Anesthesia Consultant, National Heart Center, Muscat, Oman
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7
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Hillejan L. [Management of Lung Abscess - Diagnostics and Treatment]. Zentralbl Chir 2020; 145:597-609. [PMID: 33260228 DOI: 10.1055/a-0949-7414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lung abscess is a localized infectious pus-filled cavity of the lung tissue by viral, bacterial, mycotic or parasitic pathogens. Currently, there are different classifications, which are based primarily on the genesis and duration of symptoms. Important steps for diagnosis are in addition to clinical examination, laboratory and chest X-ray especially bronchoscopy with microbiological examinations and computed tomography. Treatment of lung abscesses continues to be a domain of conservative antibiotic therapy. The vast majority of cases can be cured with this. Interventional procedures such as transthoracic or endobronchial abscess drainage with subsequent irrigation can effectively support the healing process. Thoracic surgery is particularly important in cases of failure of conservative and interventional therapy as well as secondary abscesses on the basis of a lung carcinoma. Mostly anatomical resections are required. Alternatively, VAC therapy (vacuum-assisted closure therapy) may be considered in seriously ill, old, immunosuppressed, and multimorbid patients with complicated abscesses (e.g. perforation in the pleural cavity and sero-pneumothorax).
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8
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de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet 2020; 396:786-798. [PMID: 32919518 DOI: 10.1016/s0140-6736(20)31550-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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9
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Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
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Lung abscess following bronchoscopy due to multidrug-resistant Capnocytophaga sputigena adjacent to lung cancer with high PD-L1 expression. J Infect Chemother 2018; 24:852-855. [PMID: 29703650 DOI: 10.1016/j.jiac.2018.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/03/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
Lung abscess following flexible bronchoscopy is a rare and sometimes fatal iatrogenic complication. Here, we report the first case of a lung abscess caused by multidrug-resistant Capnocytophaga sputigena following bronchoscopy. A 67-year-old man underwent bronchoscopy to evaluate a lung mass. Seven days after transbronchial lung biopsy, he presented with an abscess formation in a lung mass. Empirical antibiotic therapy, including with garenoxacin, ampicillin/sulbactam, clindamycin and cefepime, was ineffective. Percutaneous needle aspiration of lung abscess yielded C. sputigena resistant to multiple antibiotics but remained susceptible to carbapenem. He was successfully treated by the combination therapy with surgery and with approximately 6 weeks of intravenous carbapenem. Finally he was diagnosed with a lung abscess with adenocarcinoma expressing high levels of programmed cell death ligand 1. The emergence of multidrug-resistant Capnocytophaga species is a serious concern for effective antimicrobial therapy. Clinicians should consider multidrug-resistant C. sputigena as a causative pathogen of lung abscess when it is refractory to antimicrobial treatment.
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11
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Abstract
INTRODUCTION: Pediatric lung abscesses can be primary or secondary, and there is limited data regarding response to treatments and patient outcomes. OBJECTIVES: To assess the clinical and microbiologic profile of pediatric patients with lung abscess and assess the differences in outcomes for patients treated with medical therapy or medical plus surgical therapy. METHODS: A retrospective review of all pediatric patients ≤ 18 years of age that were treated as an inpatient for lung abscess between the dates of August 2004 and August 2014 was conducted. Patients were divided into two subgroups based on the need for surgical intervention. RESULTS: A total of 39 patients with lung abscess (30 treated with medical therapy alone, 9 also required surgical interventions) were included. Fever, cough, and emesis were the most common presenting symptoms, and most of the patients had underlying respiratory (31%) or neurologic disorders (15%). Staphylococcus aureus was the most common organism in those that had culture results available, and ceftriaxone with clindamycin was the most common combination of antibiotics used for treatment. Comparison of medical and surgical subgroups identified the duration of fever and abscess size as risk factors for surgical intervention. CONCLUSIONS: Pediatric lung abscesses can be managed with medical therapy alone in most cases. Presence of prolonged duration of fever and larger abscess size may be predictive of the need for surgical intervention. Good clinical response to prolonged therapy with ceftriaxone and clindamycin was noted.
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Affiliation(s)
- Kavi Madhani
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Eric McGrath
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Lokesh Guglani
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep, Children's Healthcare of Atlanta, School of Medicine, Emory University, Atlanta, GA 30322, USA
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12
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Krenke K, Krawiec M, Kraj G, Peradzynska J, Krauze A, Kulus M. Risk factors for local complications in children with community-acquired pneumonia. CLINICAL RESPIRATORY JOURNAL 2016; 12:253-261. [PMID: 27401931 DOI: 10.1111/crj.12524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the factors that could predict the development of local complications (parapneumonic effusion/pleural empyema, necrotizing pneumonia, and lung abscess) in children with community-acquired pneumonia (CAP). METHODS Demographic, clinical, and laboratory data were prospectively collected and compared in children with noncomplicated and complicated CAP. RESULTS Two-hundred and three patients aged from 2 months to 17 years were enrolled. There were 141 and 62 children with noncomplicated and complicated CAP, respectively. Significantly longer duration of fever and a higher level of acute phase reactants were demonstrated in complicated when noncomplicated to complicated CAP. Asymmetric chest pain as well as prehospital treatment with ibuprofen and acetaminophen were significantly more common in patients with complicated CAP (P < .001, P = .02 and P = .003, respectively). Preadmission cumulative dose of ibuprofen exceeding 78.3 mg/kg (median dose for the entire group) was associated with 2.5-fold higher odds ratio (OR) for CAP complications [OR 2.54 CI (1.31-4.94); P = .008)]. In contrast, pneumococcal vaccination was associated with lower odds ratio [OR.03 CI (.23-.89); P = .03] for local complications. CONCLUSIONS Some clinical and laboratory data including chest pain, longer duration of fever, higher acute phase reactants, and especially preadmission treatment with ibuprofen or acetaminophen were associated with local complications of CAP. The results of this study highlight the association between the dose of ibuprofen and local CAP complications.
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Affiliation(s)
- Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marta Krawiec
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Kraj
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzynska
- Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Krauze
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Kuhajda I, Zarogoulidis K, Tsirgogianni K, Tsavlis D, Kioumis I, Kosmidis C, Tsakiridis K, Mpakas A, Zarogoulidis P, Zissimopoulos A, Baloukas D, Kuhajda D. Lung abscess-etiology, diagnostic and treatment options. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:183. [PMID: 26366400 DOI: 10.3978/j.issn.2305-5839.2015.07.08] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Ivan Kuhajda
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Konstantinos Zarogoulidis
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Katerina Tsirgogianni
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Drosos Tsavlis
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Ioannis Kioumis
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Christoforos Kosmidis
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Kosmas Tsakiridis
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Andrew Mpakas
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Paul Zarogoulidis
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Athanasios Zissimopoulos
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dimitris Baloukas
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Danijela Kuhajda
- 1 Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 2 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 General Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece ; 4 Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 5 Nuclear Medicine Department, Democritus University of Thrace, Alexandroupolis, Greece ; 6 Oncology Department, Ptolemaida General Hospital, Ptolemaida, Greece ; 7 Center for respiratory rehabilitation, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
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Takeda K, Tanaka K, Kumamoto T, Nojiri K, Mori R, Taniguchi K, Matsuyama R, Kato H, Endo I. Septic pulmonary embolism originated from subcutaneous abscess after living donor liver transplantation: a pitfall of postoperative management. Clin J Gastroenterol 2013; 6:378-82. [PMID: 24273612 PMCID: PMC3825539 DOI: 10.1007/s12328-013-0400-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/06/2013] [Indexed: 11/12/2022]
Abstract
The use of immunosuppressants after liver transplantation (LT) is associated with postoperative complications, including infections. A 49-year-old male underwent living-donor (LD) LT because of primary sclerosing cholangitis. He was treated with tacrolimus, mycophenolate mofetil, and steroids as immunosuppressants, discharged on postoperative day (POD) 40, and re-admitted because of severe acute cellular rejection on POD 48. Three courses of steroid pulse therapy were performed, and continuous peripheral intravenous drip infusion therapy via the left forearm was necessary for 20 days because of appetite loss. The patient was discharged on POD 83, but re-admitted on POD 87 with pyrexia. A subcutaneous abscess was present at a puncture wound on the left forearm formed by an intravenous drip during the last hospital stay. Furthermore, computed tomography showed five pieces of cavitary or wedge-shaped nodules in the bilateral lung. Because sputum revealed the presence of Gram-positive coccus, and subcutaneous abscess and blood cultures revealed Staphylococcus aureus, the pathogenesis was septic pulmonary embolism (SPE) secondary to S. aureus septicemia originating from a subcutaneous abscess formed by an intravenous drip. The patient was treated with drainage of the subcutaneous abscess and antibiotic therapy, and recovered immediately. Although there have been few reports of SPE after LDLT, SPE is fatal in up to 13.3 % of patients. Early diagnosis, drainage of the infectious source, and appropriate use of antimicrobial therapy should be necessary to overcome SPE. Furthermore, the identical intravenous catheters should be removed whenever possible to avoid infectious complications including SPE for patients who receive steroid pulse therapy after LDLT.
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Affiliation(s)
- Kazuhisa Takeda
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
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Affiliation(s)
- Rani S Gereige
- Editorial Board. Department of Medical Education, Miami Children's Hospital, Miami, FL
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