Lung Abcess

Question 1

What are the pathogens responsible for lung abscess

Answer 1

Anaerobes w/aspiration
CA MRSA
Pseudomonas
Strep pneumonaie

Question 2

Acute vs chronic lung abscess

Answer 2

Acute: <4-6 weeks
Chronic: >6 weeks

Question 3

What is a primary lung abscess and the s/s

Answer 3

Anaerobic bacteria cause extensive tissue necrosis, absence of underlying pulm or systemic condition
S/S: pneumonitits, parenchymal necrosis and cavitation, posterior upper and superior lobes, foul smelling breath (typical of anaerobic cause)

Question 4

What is a secondary lung abscess and common causative organisms

Answer 4

Underlying condition, post obstructive process, systemic process
Pseudomonas, GNR MOST COMMON
Staph aureus
Legionella
Pneumocystis
Fungal

Question 5

Lung abscess diagnostics

Answer 5

CT: air fluid levels
Putrid sputum odor
Sputum cx and gram stain
Blood culture
Bronchoscopy w/ lavage
CT guided FNA

Question 6

Primary lung abscess treatment plan

Answer 6

Clindamycin until clinical improvement then transition to clindamycin po
Can also use unasyn and transition to Augmentin
Treatment duration 3-4 weeks

Question 7

Secondary lung abscess treatment plan

Answer 7

Coverage specific to organism
Abscess >6-8cm less likely to respond to ABX alone
Surgical resection
Percutaneous drain