Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation.
BACKGROUND
Lung parenchymal abscesses represent an uncommon pathology with high mortality if untreated. Although most respond well to antibiotics, the optimal therapy for persistent abscesses is unknown. The purpose of this study was to review the outcomes of percutaneous lung parenchymal abscess catheter drainage after broad-spectrum antibiotic therapy failure and correlate with patient microbiologic samples.


METHODS
Retrospective review of patients who underwent percutaneous lung abscess drainage at a tertiary hospital system from 2005 to 2015 was performed. In total, 19 procedures were identified on 16 different patients; six females and ten males. Mean patient age was 55 years (range 22-81). Median follow-up time was 7 months (range <1-78).


RESULTS
Technical success was 100%. There was one major complication, a pneumothorax. Follow-up was until tube removal or death in 100% of patients. Catheters were removed with resolution of the abscess cavity in 58% (11/19) or with non-draining abscess cavities in 21% (4/19) for a clinical success rate of 79%. Blood cultures demonstrated no growth in all cases, while 21% (4/19) of sputum or bronchoscopic cultures demonstrated growth. In comparison, the specimens from initial catheter placement isolated a causative organism in 95% (18/19) of case (p < 0.0001).


CONCLUSIONS
In cases of persistent lung abscess after broad-spectrum antibiotics, percutaneous abscess drainage is highly sensitive for microbiologic sampling compared to sputum/bronchoscopic or blood cultures. Additionally, percutaneous drainage of lung parenchymal abscess cavities may promote resolution of the abscess with high rates of therapeutic success and low complications.
Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.|Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Christopher
C
Duncan
Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.|Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Gregory J
GJ
Nadolski
Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.|Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Terence
T
Gade
Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA. Stephen.hunt@uphs.upenn.edu.|Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA. Stephen.hunt@uphs.upenn.edu.
Stephen
S
Hunt
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008169:Lung Abscess / Q000382:microbiology* / Q000628:therapy*; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D011030:Pneumothorax; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Drainage; Lung infection; Microbiology; Pulmonary abscess