The value of a CT-guided fine needle aspirate in infants with lung abscess.
OBJECTIVE
To describe the range of pathogens isolated from a lung abscess in infants less than one year of age. To assess the role of direct culture from the abscess.


METHODS
The two index cases were managed in 2002. An institution-based review was conducted of all infants up to one year of age diagnosed with a lung abscess between 1989 and 2002. Data sources were hospital's disease index and Neonatal Intensive Care Unit Audit database using ICD9 and ICD10 diagnostic codes for 'lung abscess'.


RESULTS
Five infants, under the age of one year, were treated for a lung abscess. In the one case where the abscess was left-sided it was associated with a congenital cystic adenomatoid malformation of the lung. Pathogens were isolated following direct culture of the abscess in four cases. In three cases a single pathogen was isolated: pseudomonas aeruginosa, staphylococcus aureus and haemophilus influenzae. In one case a mixture of escherichia coli, streptococcus milleri and an anaerobe, propionibacteria, were cultured. Antibiotic therapy was directed at the identified pathogen(s) in all four cases. There was no mortality or recurrence.


CONCLUSIONS
Predisposing factors for a lung abscess in infancy include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by CT-guided fine needle aspiration is recommended to direct appropriate intravenous medical therapy provided the abscess is located peripherally.
Levison
J
J
The Grace Centre for Newborn Care, The Children's Hospital at Westmead, Syndey, New South Wales, Australia. john.levison@email.cs.nsw.gov.au
Van Asperen
P
P
Wong
C
C
Harvey
J
J
Halliday
R
R
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D008169:Lung Abscess / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D011859:Radiography; D013982:Ticarcillin / Q000627:therapeutic use; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D013982:Ticarcillin