1.25 SFGH report pearls: Lung Abscesses

  • There is no strict definition of “massive hemoptysis” (i.e. hemoptysis!!! vs eh, a little hemoptysis), but the consensus UpToDate guideline is >500mL in 24 hours or more than >100mL per hour.
  • Pearl from our awesome pulm fellow, Juan: Sputum cultures are often unhelpful in guiding treatment, but there are 2 scenarios when they can help:
    • Patients with bronchiectasis
    • Critically ill patients in whom you are looking for MRSA and/or pseudomonas
  • There are way too many causes of hemoptysis to include here, but the most common causes are bronchiectasis, bronchitis and bronchogenic carcinoma in developed countries. TB and Paragonimus westermani are the most common causes in other parts of the world.
  • Most patients with lung abscesses have anaerobic infections, which typically present over weeks to months. Patients with necrotizing pneumonia due to virulent organisms (s. pneumo, etc) often have abrupt onset of symptoms, but infection with anaerobes is often indolent.
    • Think about anaerobic infection in patients with poor dentition who are prone to aspiration and may also have constitutional symptoms
  • Anaerobic lung abscesses are usually polymicrobial, and treatment generally consists of a clindamycin or a combination of a beta lactam/beta-lactamase inhibitor (amp/sulbactam).

o   Duration of therapy varies, but usually depends on radiographic findings and antibiotics are continued until chest imaging is clear or there is a small stable residual lesion, which can take weeks to months!

Evernote: https://www.evernote.com/shard/s300/sh/c65fea75-3be4-4727-83fc-5592acdf4762/900f6b02729b3a20dfb76657e3cc26a8

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