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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Pursuing a microbiological diagnosis in suppurative lung disease can enable focused antibiotic therapy, identify pathogens of potential concern for infection control, and in some cases delineate a specific pathological process. Suppurative lung disease can be categorized as acute or chronic. Acute disease most commonly consists of lung abscess or parapneumonic empyema. The vast majority of chronic suppurative lung disease in childhood is due to cystic fibrosis. Samples from the respiratory tract offer the most useful information for diagnosis and management, but adjunctive information can also be obtained from serological methods, blood cultures and molecular techniques. The quality of respiratory tract samples is vital to aid accurate interpretation of results, and this varies according to the technique of collection. Antibiotic sensitivity testing is of particular importance in an era of evolving antibiotic resistance and can be problematical in cystic fibrosis.
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Affiliation(s)
- M L May
- Department of Microbiology, Sullivan Nicolaides Pathology, Brisbane, Australia.
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Moreira JDS, Camargo JDJP, Felicetti JC, Goldenfun PR, Moreira ALS, Porto NDS. Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004. J Bras Pneumol 2006; 32:136-43. [PMID: 17273583 DOI: 10.1590/s1806-37132006000200009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 09/23/2005] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Apresentar a experiência de um serviço especializado em doenças respiratórias no manejo de casos de abscesso pulmonar de aspiração. MÉTODOS: Descrevem-se aspectos diagnósticos e resultados terapêuticos de 252 casos consecutivos de pacientes com abscesso de pulmão, hospitalizados de 1968 a 2004. RESULTADOS: Dos 252 casos, 209 ocorreram em homens e 43 em mulheres, com média de idade de 41,4 anos. Eram alcoolistas 70,2% dos pacientes. Tosse, expectoração, febre e comprometimento do estado geral ocorreram em mais de 97% dos casos, 64% tinham dor torácica, 30,2% hipocratismo digital, 82,5% apresentavam dentes em mau estado de conservação, 78,6% tiveram episódio de perda de consciência e 67,5% apresentavam odor fétido de secreções broncopulmonares. Em 85,3% dos casos as lesões localizavam-se nos segmentos posterior de lobo superior ou superior de lobo inferior, 96,8% delas unilateralmente. Em 24 pacientes houve associação de empiema pleural (9,5%). Flora mista foi identificada em secreções broncopulmonares ou pleurais em 182 pacientes (72,2 %). Todos os doentes foram inicialmente tratados com antibióticos (principalmente penicilina ou clindamicina) e 98,4 % deles foram submetidos à drenagem postural. Procedimentos cirúrgicos foram efetuados em 52 (20,6%) pacientes (24 drenagens de empiema, 22 ressecções pulmonares e 6 pneumostomias). Cura foi obtida em 242 pacientes (96,0%) e 10 faleceram (4,0%). CONCLUSÃO: O abscesso pulmonar de aspiração ocorreu predominantemente em indivíduos adultos masculinos com doença dentária e episódio antecedente de perda de consciência (especialmente por alcoolismo). A maioria dos pacientes foi tratada clinicamente (antibióticos e drenagem postural). Um quinto deles submeteu-se a algum procedimento cirúrgico.
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Affiliation(s)
- José da Silva Moreira
- Universidade Federal do Rio Grande do Sul, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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