Treatment of community-acquired lung abscess associated with aspiration

Abstract

The management of community-acquired lung abscess associated with aspiration is based on adequate antimicrobial treatment and effective drainage. Empiric antimicrobial treatment should cover basic microbial patterns and consist of aminopenicillin/beta-lactamase-inhibitor or clindamycin. Since the spectrum of clindamycin is restricted to Gram-positive microorganisms combination treatment of clindamycin with a second-generation cephalosporin may be warranted. It is crucial to continue antimicrobial treatment until complete resolution of the abscess cavity and the corresponding infiltrates. Drainage is frequently present spontaneously. Additional techniques to ensure effective drainage include bronchoscopic and percutaneous drainage. These techniques are only infrequently indicated in case of clinical failure and of delayed cavity closure. Indications for surgical emergency interventions are mainly limited to severe pulmonary hemorrhage. The clinical success rate of adequate antimicrobial treatment together with effective drainage reaches 75 - 90 %.