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  • UpToDate Management of Bacterial Lung Abscess in Adults

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    Atif Hussain
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    This document discusses the management of bacterial lung abscesses in adults. Most lung abscesses result from aspiration of oral bacteria and can be treated with antibiotic therapy alone. Empiric antibiotic selection is based on the suspected pathogens and route of infection. For abscesses resulting from aspiration, regimens targeting oral flora are appropriate. Additional testing may be needed if less common pathogens are suspected or the patient has specific exposures. Flexible bronchoscopy or drainage procedures may be considered if antibiotics are not improving the abscess.

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    This document discusses the management of bacterial lung abscesses in adults. Most lung abscesses result from aspiration of oral bacteria and can be treated with antibiotic therapy alone. Empiric antibiotic selection is based on the suspected pathogens and route of infection. For abscesses resulting from aspiration, regimens targeting oral flora are appropriate. Additional testing may be needed if less common pathogens are suspected or the patient has specific exposures. Flexible bronchoscopy or drainage procedures may be considered if antibiotics are not improving the abscess.

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    47 views2 pages

    UpToDate Management of Bacterial Lung Abscess in Adults

    Uploaded by

    Atif Hussain
    This document discusses the management of bacterial lung abscesses in adults. Most lung abscesses result from aspiration of oral bacteria and can be treated with antibiotic therapy alone. Empiric antibiotic selection is based on the suspected pathogens and route of infection. For abscesses resulting from aspiration, regimens targeting oral flora are appropriate. Additional testing may be needed if less common pathogens are suspected or the patient has specific exposures. Flexible bronchoscopy or drainage procedures may be considered if antibiotics are not improving the abscess.

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    © All Rights Reserved
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    Management of bacterial lung abscess in adults

    Most lung abscesses result from aspiration and are polymicrobial, composed of oral flora (eg, microaerophilic
    streptococci and anaerobes, such as Peptostreptococcus, Prevotella, Bacteroides, and Fusobacterium spp). Less
    commonly, lung abscesses arise from complications of pneumonia caused by pyogenic bacteria (eg, Klebsiella
    pneumoniae, Staphylococcus aureus), from direct extension (eg, traumatic inoculation), or endobronchial
    obstruction. The majority of lung abscesses can be treated with antibiotic therapy alone. Empiric antibiotic selection
    varies based on the suspected route and suspected pathogen. For most lung abscesses that result from aspiration, a
    regimen that targets oral flora is appropriate (Box 1). Modifications to the regimen may be needed when drug-
    resistant or other less common pathogens are suspected. Refer to UpToDate topic on lung abscess for details.

    CT: computed tomography; IV: intravenous; PO: oral.

    * Additional evaluation may be needed for patients who live in areas where certain pathogens are endemic or who
    have specific exposure to such pathogens (eg, Mycobacterium tuberculosis, Entamoeba histolytica, Paragonimus
    westermani, or Echinococcus). Refer to UpToDate content.
    ¶ Flexible bronchoscopy is performed in most patients with a lung abscess that is not responding to antibiotic
    therapy unless the abscess is subpleural and a drainage procedure is already planned or the patient would not
    tolerate the procedure.
    Δ When lung abscess drainage is necessary, the preferred route is usually percutaneous CT-guided catheter rather
    than endobronchial catheter. Factors favoring percutaneous drainage include a peripheral location with abscess and
    its surrounding inflammation abutting (or close to) chest wall. Placement of a percutaneous catheter carries risk of
    pneumothorax and pleural spillage. Transbronchial catheter drainage requires interventional pulmonary expertise
    with endobronchial ultrasound. It may be preferred for centrally located abscesses that are difficult to access
    percutaneously.

    Graphic 133181 Version 2.0

    © 2023 UpToDate, Inc. All rights reserved.

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