Lung abscess: Clinical characteristics of 222 Danish patients diagnosed from 2016 to 2021

Aetiology of Adult Community-Acquired Lung Abscess in Hong Kong

BACKGROUND AND OBJECTIVE

Knowing the pattern of pathogens in community-acquired lung abscess (CALA) is important in the choice of initial empiric antibiotics. Early studies established the anaerobes as the predominant pathogen, followed by aerobic streptococci and aerobic Gram-negative bacilli. However, recent reports indicated that Klebsiella pneumoniae and aerobic streptococci predominated.

METHODS

We performed a retrospective study on CALA cases from all public hospitals in Hong Kong over a nine-year period. Only cases with uncontaminated specimens sent for bacterial culture were included. Cases caused by mycobacteria and fungi were excluded.

RESULTS

There were 606 eligible subjects-episodes. Mean age of subjects was 57.7 years and male to female ratio was 3.3:1. Two hundred and thirty-two subjects had at least one positive bacterial culture, with a total of 338 pathogens isolated. Anaerobes were the predominant pathogen group with 103 isolates (30.5% of total). This was followed by aerobic streptococci (90, 26.6%), aerobic Gram-negative bacilli (67, 19.8%), and Staphylococcus aureus (56, 16.6%). Isolation of Staphylococcus aureus was closely linked to intravenous drug abuse, while isolation of Klebsiella pneumoniae (28 cases) was related to extrapulmonary abscesses, particularly of the liver. There were 14 cases of Pseudomonas aeruginosa with underlying chronic lung disease and major organ failure being risk factors.

CONCLUSION

Anaerobes and aerobic streptococci appear to be the major pathogens for primary CALA. Secondary lung abscess caused by haematogenous spread is commonly attributable to Staphylococcus aureus or Klebsiella pneumoniae. Choice of empiric antibiotics should take these into consideration together with local patterns of antibiotic resistance.

Heterogeneity in clinical patterns of adult lung abscess patients: an 8-year retrospective study in a tertiary hospital

BACKGROUND

The widespread use of broad-spectrum antibiotics has led to changes in both the microbiological and clinical characteristics of lung abscesses. It is necessary to re-evaluate the bacterial spectrum associated with these infections. As a novel method for pathogen detection, metagenomic next-generation sequencing (mNGS) is increasingly being applied in clinical practice. There is limited research evaluating the use of mNGS in patients with lung abscesses.

METHODS

A retrospective analysis was conducted on patients with lung abscess who were hospitalized between July 2015 and July 2023 at a teaching hospital in China. Patients who underwent both computerized tomography (CT) imaging and conventional pathogen testing were included in the study. The efficacy of pathogen detection using conventional methods was compared with that of mNGS. Additionally, the clinical and radiological features were analyzed to provide a comprehensive understanding of the disease patterns.

RESULTS

A total of 782 patients with lung abscess were included in the study and hematogenous abscess accounting for 7.16% (56/782) of cases. The overall hospital mortality rate was 1.53%. The mean age of the patients with lung abscess was 60 years, with a male predominance (80.2%). A significant proportion of patients had comorbid conditions, including diabetes (29.7%) and cardiovascular disease (18.2%). Lung abscesses were predominantly located in the right lung, and pleural effusion was more commonly observed in the deceased group. The detection rate of pathogen via conventional test was lower at 41.8% (327/782). Among patients with positive mNGS results, only 51.9% had pathogens identified through conventional testing methods. Klebsiella pneumoniae was the most frequently detected pathogen by conventional culture, while mNGS identified was Parvimonas micra. Infections caused solely by anaerobic bacteria or facultative anaerobes were associated with shorter hospital stays. Patient infected with Gram-negative bacilli (GNB) had a higher proportion of liver abscesses (11.8%).

CONCLUSION

Compared to conventional testing methods, mNGS demonstrates superior performance in detecting anaerobic and facultative anaerobic bacteria. The low detection rate of conventional tests may result in an underestimation of the clinical significance of anaerobic bacteria infections. In patients with lung abscess caused by GNB, hematogenous dissemination, liver abscess and diabetes were more commonly observed and these patients tended to have longer hospital stays.

Ruptured Lung Abscess Into the Pleural Cavity: The Significance of Imaging and Medication Compliance

A lung abscess is defined as a necrotizing infection with a pus-filled cavity. The infection can be primary in a previously normal lung or secondary to a pre-existing condition such as bronchial obstruction or immunosuppression by HIV or steroid use. Abscesses are more common in men aged 54-74 years, with a history of smoking, alcohol or other sedative use, and immunodeficiency. We present a case of a 65-year-old male with a past medical history of chronic obstructive pulmonary disease (COPD) who presented two months following a necrotizing pneumonia infection and was diagnosed with an acute pulmonary embolism. Due to repeated imaging, an incidental left lower lobe abscess rupture with a bronchopleural fistula was discovered. This case emphasizes the importance of previous chest imaging to establish the disease course, response to therapy, medication compliance, and evaluation for intervention, particularly in underserved populations.

Recovery of temperature to normal may indicate the best time for surgery in patients with lung cancer complicated by a lung abscess: A case report

In clinical practice, the management of a lung abscess (LA) usually initiates with antibiotic administration to address the infection. Nevertheless, for cases presenting with refractory pulmonary tumors complicated by a LA, surgical intervention stands as an essential therapeutic recourse. The current study presents case involving lung cancer complicated by a LA. Despite continuously elevated infection marker levels, surgical intervention was promptly performed following the normalization of the patient's temperature. Subsequent postoperative histopathological analysis and immunohistochemistry revealed a moderately differentiated squamous cell carcinoma located in the lower right lung, classified as T2aN0M0, Ib stage. Following a 2-year follow-up period, no cancer recurrence was observed and the patient exhibited a favorable prognosis. This case highlights the vital role of surgical timing in the management of lung cancer complicated by an acute LA. Early surgical intervention may play a crucial role in arresting the advancement of lung cancer, indicating that prompt surgery upon temperature normalization could serve as a significant treatment indication for these patients.

Artificial intelligence for the optimal management of community-acquired pneumonia

PURPOSE OF REVIEW

This timely review explores the integration of artificial intelligence (AI) into community-acquired pneumonia (CAP) management, emphasizing its relevance in predicting the risk of hospitalization. With CAP remaining a global public health concern, the review highlights the need for efficient and reliable AI tools to optimize resource allocation and improve patient outcomes.

RECENT FINDINGS

Challenges in CAP management delve into the application of AI in predicting CAP-related hospitalization risks, and complications, and mortality. The integration of AI-based risk scores in managing CAP has the potential to enhance the accuracy of predicting patients at higher risk, facilitating timely intervention and resource allocation. Moreover, AI algorithms reduce variability associated with subjective clinical judgment, promoting consistency in decision-making, and provide real-time risk assessments, aiding in the dynamic management of patients with CAP.

SUMMARY

The development and implementation of AI-tools for hospitalization in CAP represent a transformative approach to improving patient outcomes. The integration of AI into healthcare has the potential to revolutionize the way we identify and manage individuals at risk of severe outcomes, ultimately leading to more efficient resource utilization and better overall patient care.

Lung abscess: an update on the current knowledge and call for future investigations

PURPOSE OF REVIEW

Lung abscess is a severe and complex respiratory infection. The purpose of this review is to discuss recent publications on lung abscess, covering topics such as epidemiology, clinical presentation, diagnosis, and treatment and prevention.

RECENT FINDINGS

Risk factors associated with lung abscess include structural lung disease, poor dental hygiene, and ventilator-associated pneumonia, while concerns are now raised regarding the potential of electronic cigarettes use as a risk factor. The complexity of lung abscess is reflected by the relative high number of case reports describing rare and complex cases. Early transthoracic drainage could improve in-hospital outcomes, while next-generation sequencing could become an important tool in diagnostics and future clinical studies.

SUMMARY

High-quality evidence and guidelines to support treatment of lung abscess are lacking. Despite advancements, we call for prospective studies to evaluate the use of invasive procedures and antibiotic treatment regimens.