Clindamycin in Treatment of Lung Abscess in Children

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.

Lung abscess is a very rare infectious condition in children and is most commonly encountered as a complication of bacterial pneumonia. The majority of patients with lung abscess show an excellent response to antibiotic therapy and only in a minor group of cases, simple drainage or other surgical interventions are required. Empiric parenteral antibiotic therapy is the gold standard in treatment of lung abscess in children. Here we present a 2.5 year-old girl who developed lung abscess during the course of a lobar pneumonia and required percutaneous drainage due to failure of resolution with conventional antibiotic therapy.

Paediatric Respiratory Reviews, 2007

A lung abscess is a thick-walled cavity that contains purulent material resulting from a pulmonary infection. It is an uncommon condition that can occur at any age. It is believed to be less common in children than adults, and the literature is accordingly relatively sparse. The pathogenesis of lung abscess involves an area of initial pneumonitis that leads to necrosis, cavitation and abscess formation. 1 It is initiated or complicated by infectious organisms such as streptococcal and staphylococcal species. 1,2 Some series impose a minimum size of 2 cm as a diagnostic criterion. 1,2 PAEDIATRIC RESPIRATORY REVIEWS (2007) 8, 77-84

Cureus

Boucher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Revista Portuguesa de Pneumologia (English Edition), 2009

Resumo Abcessos pulmonares (AP) acarretam graves implicações clínicas e sociais. Os autores analisam retrospectivamente a casuística dum hospital terciário. Identificaram-se 60 internamentos por AP ocorridos entre 2000 e 2005. Quarenta e cinco doentes eram homens; a idade média foi 56,2 (±15,1) anos. A duração média dos sintomas de pré-hospitalização foi de 23,0 (±50,2) dias, mas a infecção respiratória aguda foi o modo de apresentação em 36 doentes. Em 40 casos, com base em dados clínicos, a suspeita de AP seria elevada. O diagnóstico estabeleceu-se em 8,7 (±11,4) dias após a admissão. Identificou-se agente microbiano em 26 casos. Em 27 doentes classificou-se o AP como primário. Mau estado dentário e imunodeficiência foram os principais factores de risco. Exis-Abstract Lung abscesses (LA) carry with them severe clinical and social implications. The authors retrospectively analyse case files from a tertiary hospital. Admissions from 2000 to 2005 codified as LA were identified. Forty-five patients were males and the mean age was 56.2 (±15.1) years. The average duration of symptoms pre-hospitalisation was 23.0 (±50.2) days, with acute respiratory infection the initial syndrome in 36 patients. Clinical data show LA could have been suspected in 40 patients. Diagnosis was established 8.7 (±11.4) days after admission. A microbial pathogen was recovered in 26 cases. Primary LA was diagnosed in 27 patients. Dental disease and immunodeficiency were the main risk factors. Other co-morbidities were present in 34 patients. Af-Abcessos pulmonares: Revisão de 60 casos Lung abscesses: Review of 60 cases Recebido para publicação/received for publication: 07.11.16 Aceite para publicação/accepted for publication: 08.10.13

Pediatric Radiology, 1999

The treatment for lung abscess has changed from antibiotic treatment alone [1] to physical therapy [2], endobronchial intervention [3], and surgical intervention [1, 4]. In 80±90 % of cases, lung abscess responds to antibiotic therapy alone [4]. Simple therapeutic needle aspiration [5±8] may hasten the recovery and identify the organism. More invasive percutaneous catheter drainage has been recommended for lung abscesses refractory to medical treatment [1, 4, 9±12]. Necrotizing pneumonia [13±16], also termed massive pulmonary gangrene [17±19], is a sequela of pneumonia in which the lung tissue becomes necrotic. There are various bacterial etiologies in adults [17, 18] including Streptococcus pneumoniae [14, 15, 19], and all are asso

Hospital Pharmacology - International Multidisciplinary Journal, 2020

Introduction: Community-acquired pneumonia is one of the most common diseases in infancy but most of these diseases have relatively simple course. We are presenting a case of child who developed lung abscess as a complication of pneumonia. Case Report: The goal of our case report is to point out that lung abscess is a relatively rare entity whose development is not always typical, sudden and acute, but also hidden, inconspicuous and perfi dious. Although clinical picture and laboratory fi ndings indicated that the pneumonia was cured, a single control CT scan showed that there was infl ammation (hotspot) in the organism. Discussion: Lung abscess is a rare state which is developed as a complication only at 1% of pneumonias. Complications are rare and depend on the previous immunological status of the child and the presence of comorbidity. The duration of antibiotic therapy depends on the clinical and radiographic response of the patient. The chosen antibiotics have to cover a wide specter of Gram-positive and Gram-negative bacteria. Conclusions: The key role in making a diagnosis played radiological methods which were crucial in monitoring the evolution of the change itself, from its creation to regression. The triple antibiotic therapy with meropenem, vancomycin and metronidazole enabled an (excellent) recovery outcome.

1999

Background: The rates of morbidity and mortality associated with lung abscess are still significant despite the introduction of antibiotic treatments. The aim of this work was to identify the factors that predict a poor outcome for patients with lung abscess. Methods: We retrospectively reviewed the records and the roentgenographic files of adult patients with lung abscess who were hospitalized from 1980 to 1996 at the Hadassah University Hospital, in Jerusalem, Israel. Results: The study population comprised 75 patients, and the mean age was 52 years old (range, 12 to 89 years). The mean (؎ SD) hospitalization duration was 25.7 ؎ 21.5 days (range, 5 to 94 days). Fifteen patients (20%) succumbed to the infection. The patients who died had more predisposing factors (؎ SD), such as pneumonia, neoplasm, and altered consciousness, than those who survived, respectively: 2.73 ؎ 1.4 vs 1.9 ؎ 1.3 (p < 0.03). The patients with anemia on admission (hemoglobin levels of < 10 g/dL) had a higher mortality rate than those with higher hemoglobin levels, respectively: 58.3 vs 12.9% (p ‫؍‬ 0.0008). A higher mortality rate was also associated with infection by Pseudomonas aeruginosa (83%), Staphylococcus aureus (50%), and Klebsiella pneumoniae (44%). The patients who died had larger abscess volumes (؎ SD) than those who survived (233 ؎ 99 vs 157 ؎ 33 mL), although it did not reach statistical significance. The diameter of the abscess correlated with the hospitalization time (r ‫؍‬ 0.5; p < 0.001). Conclusion: High rates of morbidity and mortality are associated with lung abscess despite appropriate antibiotic therapy and better supportive care. In patients with several predisposing factors, such as a large abscess size and a right-lower-lobe location, the prognosis was worse. The patients infected with S aureus, K pneumoniae, and particularly P aeruginosa had an ominous prognosis. As the prognosis for lung abscess has not improved sufficiently since the introduction of antibiotics, other modalities should be considered for patients with poor prognostic signs.

PULMONARY ABSCESS IN CHILDREN ADMITTED TO THE DAVID BERNARDINO PEDIATRIC HOSPITAL (ANGOLA): CASE STUDY (2018-2019) (Atena Editora), 2022

Introduction: Lung abscesses are cavities in the lung parenchyma with necrotic lung tissue and fluid inside. Objective: To describe the characteristics of children admitted to the David Bernardino Pediatric Hospital with lung abscess from June 2018 to February 2019. Methodology: Prospective descriptive study carried out in 18 children and adolescents aged 2 months to 14 years, admitted to the David Bernardino Pediatric Hospital with pulmonary abscess confirmed by chest X-ray. Through a form, information on clinical processes and companions, the variables age, sex, nutritional status, vaccination, clinical manifestations, previous antibiotic therapy, underlying diseases, radiological findings, type of abscess, type and duration of treatment and complications were evaluated and analyzed. Results: The most affected age group was 5-9 years old, with 50% of cases. The most frequent symptom was fever (100%), followed by cough and dyspnea with 94.4 and 38.9% of cases, respectively. Malnutrition was present in 16.7% of the cases. 66.7% of the children presented a vaccination card, of which 44.4% had a complete vaccination schedule for their age. In 88.9% of the cases the abscesses were single, 66.7% secondary. and 94.4% were located in the right lung. Clindamycin and postural drainage was the treatment instituted in 100% of the cases. Pleural effusion and empyema were complications in 5.6 % of cases. The mean hospital stay was 19.7 days. 94.4% of children were discharged. Conclusion: Lung abscess is a rare complication of pneumonia in children and is often secondary to foreign body aspiration. Despite being severe, the prognosis is good.

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. Figure 9 Chest tube drainage with Seldinger technique. Kuhajda et al. Lung abscess-etiology, diagnostic and treatment