Lung abscess: 14 years of experience in a tertiary paediatric hospital

Abstract

Background Lung abscess is a rare condition in paediatrics with a paucity of literature. Intravenous antibiotics is the main therapy; however interventional radiological approaches have led to the use of percutaneous drainage. Surgery is reserved for the management of complications. The aim of this study was to describe lung abscess in a cohort of paediatric patients' and determine associations between factors at presentation and outcomes. Methods A 14‐year retrospective cohort study was conducted including all children who presented to a tertiary paediatric hospital in Western Australia with lung abscess. Clinical characteristics, laboratory and radiologic findings, management options and clinical outcomes were examined. Results Sixty‐eight patients (median age 3.6 (0.08–17.6) years; 44.1% female) were identified to have a lung abscess, with 81% being primary lung abscess. Staphylococcus aureus (including MRSA) and Streptococcus pneumoniae were the most common organisms identified, with S. aureus being most common in Aboriginal patients (80%). A total of 25 antibiotics were prescribed on initiation of treatment in over 20 combinations. 44.9% of patients had complications and hospitalization was prolonged. Patients with S. aureus had longer hospitalization (20.5 days (3–67) than those without (median 13 days (3–52), p = 0.04). There were no associations between factors at presentation and subsequent outcomes. Factors at presentation were not associated with outcomes. Conclusion There is unwarranted variation in management of paediatric lung abscess and high complication rates. There is a need for collaboration and clinical practice guidelines to standardize care for lung abscess in children.

Point-of-care ultrasound in early diagnosis and monitoring of deep abscess in newborns: a case report of two cases

“…It is an important tool for diagnosing respiratory diseases and can provide more detailed details than chest x-ray ( 32 ). Combined with literature reports ( 33 ), The common etiology of pulmonary abscess is Staphylococcus aureus and Streptococcus pneumoniae , so before the etiology was not clear, ambenicillin was empirically given intravenously for anti-infection. On the third day, the throat swab was positive for chlamydia trachomatis-DNA, and azithromycin was changed to oral anti-infection.…”

“…During hospitalization and after discharge, B-ultrasound and CT of the lungs were closely monitored, and the abscess gradually shrank, so there was no surgical intervention. The literature reports that the time range of intravenous antibiotic use in children with pulmonary abscess is large, the shortest 3 days ( 33 ). In this case, intravenous antibiotics were used for 3 days and oral antibiotics for 5 days.…”

Lung Abscess Case Series and Review of the Literature

“…The literature on pediatric lung abscess case series is scarce [ 3 ]. Dhanushke et al reported unwarranted variation in the management of pediatric lung abscesses with an alarmingly prolonged hospitalization [ 10 ]. Studies have reported fever, cough, and dyspnea as the most common symptoms of lung abscess [ 11 , 12 ].…”

“…The yield of blood cultures in our cases was negative. Currently, the increase in the interventional approach might increase the yield of pathogens responsible for lung abscess from 30% to potentially 60% [ 10 , 13 , 14 ].…”

“…Three of our cases were secondary lung abscesses, and only one was primary. However, in a newly published Australian study, it was found that among 68 cases, 81% were predominantly primary and Staphylococcus aureus (including MRSA) was the commonest organism at 80% [ 10 ].…”