Surgical Treatment of 26 Patients with Necrotizing Pneumonia

Abstract

Background: This study aimed to review the outcome of patients treated with surgical resection for necrotizing lung infection with various co-morbidities and complications. Methods: The records of 26 patients treated with pulmonary resection for necrotizing pneumonia between July 2004 and January 2010 were retrospectively reviewed. Surgical procedures included large wedge resection (n = 1), lobectomy (n = 19) and bilobectomy (n = 6). Results: The study cohort consisted of 21 men and 5 women aged 35–85 years (mean 64.7 ± 15.0 years). Twenty-three (88.5%) patients had underlying risk factors. At surgical consultation, 17 patients presented with progressive respiratory distress; 6 required ventilatory support; 12 had empyema, and in 5 patients the conditions were complicated by bronchopleural fistula. Four patients had septic shock requiring vasopressor support. Three patients developed hemoptysis. Two patients had bilateral diffuse pneumonia. Klebsiella pneumoniaeand Streptococcusviridans were the most common pathogens. The right lower (n = 13) and right middle lobes (n = 10) were the most frequently affected. Four deaths (15.4%) occurred: 3 due to perioperative progressing pulmonary infection/inflammation and 1 due to hepatorenal failure. Postoperative empyema occurred in 3 patients. One patient became ventilator dependent. Conclusion: Pulmonaryresection for necrotizing pneumonia is a feasible treatment option in patients with progressive pulmonary sepsis.

Surgical Therapy for Necrotizing Pneumonia and Lung Gangrene

“…The above-cited Taiwanese study showed fatal outcome in 4 out of 26 cases which resulted in a similar mortality of 15%. 16 Two of our three postoperative deaths occurred following emergency pneumectomy whereas 12 out of 13 patients with lobectomy recovered. Hence, it seems reasonable that further improvement of results is achievable by timely surgical intervention when pneumectomy is still avoidable and limited procedures or lobectomy can safely be performed.…”

“…These findings are also affirmed by recent series from Taiwan comprising 26 patients with necrotizing pneumonia. 16 Chronic alcoholism was present in nearly onethird of the sufferers and upon referral for surgical therapy 50% had already sustained pleural empyema whereas respiratory failure, persisting air leakage, and septic shock were each encountered in 20%.…”

Necrotising Pneumonia in War Victims: Two Case Reports

“…Hasta pnömoni ön tanısı ile göğüs hastalıkları servisine yatırıldı. (3,6). Nadir görülen bir durum olduğundan prognoz ve mortalite ile ilişkili yeterince veri olmamakla beraber çoğunlukla kötü prognozludur.…”

Lung Resection in Children with Necrotizing Pneumonia: Outcome and Follow-up

“…The incidence of necrotizing pneumonia has increased in recent years. [1][2][3][4] Staphylococcus aureus is the most commonly implicated agent, followed by Streptococcus pneumoniae. 5 Predisease, most patients are healthy young children who, despite adequate conservative treatment for pneumonia, remain febrile with deteriorating health.…”