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18]

Original Article

A 10‑year retrospective review of

pediatric lung abscesses from a single
center
Kavi Madhani, Eric McGrath1, Lokesh Guglani2

Department of Abstract:
Pediatrics, Division of INTRODUCTION: Pediatric lung abscesses can be primary or secondary, and there is limited data regarding
General Pediatrics, response to treatments and patient outcomes.
Children’s Hospital of OBJECTIVES: To assess the clinical and microbiologic profile of pediatric patients with lung abscess and assess
Michigan, 1Department the differences in outcomes for patients treated with medical therapy or medical plus surgical therapy.
of Pediatrics, METHODS: A retrospective review of all pediatric patients ≤ 18 years of age that were treated as an inpatient
Division of Pediatric for lung abscess between the dates of August 2004 and August 2014 was conducted. Patients were divided into
Infectious Diseases, two subgroups based on the need for surgical intervention.
Children’s Hospital RESULTS: A  total of 39 patients with lung abscess (30 treated with medical therapy alone, 9 also required
of Michigan, Detroit, surgical interventions) were included. Fever, cough, and emesis were the most common presenting symptoms,
MI 48201, 2Division and most of the patients had underlying respiratory (31%) or neurologic disorders (15%). Staphylococcus aureus
of Pulmonology, was the most common organism in those that had culture results available, and ceftriaxone with clindamycin was
Allergy/Immunology, the most common combination of antibiotics used for treatment. Comparison of medical and surgical subgroups
identified the duration of fever and abscess size as risk factors for surgical intervention.
Cystic Fibrosis and
Sleep, Children’s CONCLUSIONS: Pediatric lung abscesses can be managed with medical therapy alone in most cases. Presence
of prolonged duration of fever and larger abscess size may be predictive of the need for surgical intervention.
Healthcare of Atlanta,
Good clinical response to prolonged therapy with ceftriaxone and clindamycin was noted.
School of Medicine,
Emory University, Key words:
Atlanta, GA 30322, Abscess, anaerobes, antibiotics, bacterial, empyema, infections, lung, microbiology pediatric, pneumonia, surgery
USA

L
Address for ung abscesses are thick‑walled cavities that secondary lung abscesses. Treatment with empiric
correspondence: contain purulent material and result from broad‑spectrum antibiotics is initiated until the
Dr. Lokesh Guglani,
an acute pulmonary infection that has led to causative organism is identified[2,4,6] through
Children’s Healthcare of
Atlanta, 2015 Uppergate
suppurative necrosis and destruction of the respiratory cultures, but in many cases, cultures
Drive, Atlanta, involved lung parenchyma.[1‑3] Treatment with are not clinically feasible. Invasive procedures
GA 30322, USA. prolonged duration of antibiotics with or without such as surgical open drainage, lobectomy
E‑mail: lokesh.guglani@ drainage of the abscess cavity has been the and/or percutaneous drainage are reserved for
emory.edu standard of care. It is also important to recognize cases with persistent infection despite antibiotic
Submission: 17‑02‑2016
the complications associated with lung abscesses therapy.[1,2,4] Prognosis is good for primary lung
Accepted: 24‑03‑2016 in children, and there could be several factors abscesses,[1,4] while the nature of the underlying
that predispose some patients or increase their disease is important for determining the outcome
risk for having those complications.[1] of secondary lung abscesses.[2]

Lung abscesses have been classified This is an open access article distributed
Access this article online as primary (without any lung or systemic under the terms of the Creative Commons
Quick Response Code: disorders) or secondary (with preexisting Attribution‑NonCommercial‑ShareAlike 3.0 License,
lung or systemic disorders). Primary pediatric which allows others to remix, tweak, and build upon
lung abscesses are most commonly caused by the work non‑commercially, as long as the author is
Streptococcus pneumoniae,[4] Staphylococcus aureus, credited and the new creations are licensed under
and oral bacteria. [5] For secondary lung the identical terms.
abscesses, the most common pathogen is
Pseudomonas aeruginosa.[4] Multiple studies have For reprints contact: [email protected]
Website: also advocated for assessment and coverage
www.thoracicmedicine.org for anaerobic bacteria [1,6] but there are no How to cite this article: Madhani K, McGrath E,
conclusive data regarding the prevalence of these Guglani L. A 10-year retrospective review of pediatric
DOI: lung abscesses from a single center. Ann Thorac Med
organisms in pediatric lung abscess patients.
10.4103/1817-1737.185763 2016;11:191-6.
Fungal infections can be found in patients with

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Madhani, et al.: Pediatric lung abscess treatment and outcomes

For many of the aspects related to the management of pediatric Therefore, 39 total patients were included in this study, of
lung abscess (such as optimal duration of antibiotics, need for which 22 were male (56%) [Table 1]. Further subgroups were
open surgical drainage), there is still inadequate evidence in
the literature. Hence, this study was initiated to understand
Table 1: Demographic and clinical profile of pediatric
the clinical characteristics, causative organisms, treatments
patients with lung abscess
utilized, associated complications, and the final outcomes of
pediatric lung abscesses treated at a single center over 10 years. Characteristics Total, n (%) Medical, n (%) Surgical, n (%)
Demographics
Methods Average age at 7 10
(years) presentation
We conducted a retrospective chart review of all cases of Males 22 (56) 18 (81) 4 (18)
pediatric lung abscesses that were treated as an inpatient at Race
the Children’s Hospital of Michigan (CHM) over 10 years African-American 59 19 (63) 4 (44)
(August 2004 to August 2014). The patients were screened from Caucasian 23 6 (20) 3 (33)
their hospital discharge diagnoses using the ICD‑9 codes for Hispanic 10 3 (10) 1 (11)
pediatric lung abscesses (513.0, 519.9, and 510.9). We included Middle Eastern 5 2 (7) 0 (0)
all patients ranging from newborns to 18 years of age, with Unknown 2 0 (0) 1 (11)
a diagnosis of lung abscess who were admitted for inpatient Underlying medical
therapy at our institution. We excluded all instances of repeat conditions
admissions for a known case of lung abscess already undergoing None 11 (28) 8 (73) 3 (27)
treatment. The study was approved by the Wayne State Respiratory 12 (31) 11 (61) 1 (6)
University’s Institutional Review Board (Protocol #045614MP4E). Neurological 6 (15) 4 (29) 2 (14)
General 2 (5) 2 (22) 0 (0)
Information about the clinical presentation such as presenting Gastrointestinal 2 (5) 2 (33) 0 (0)
symptoms and their duration; laboratory studies and culture
Immunodeficiency 1 (3) 0 (0) 1 (50)
results  (when available); the type of organisms identified
Cardiac 2 (5) 1 (50) 1 (50)
and the treatment choices made for empiric and subsequent
Renal 2 (5) 1 (50) 1 (50)
antibiotic therapy and its duration were gathered from patient
records. We also screened the charts for any pulmonary and Endocrine 1 (3) 1 (100) 0 (0)
systemic complications related to lung abscesses. Imaging Multisystem 15 (38) 10 (66) 5 (33)
studies were used to determine the size of abscess (using Presenting signs and
the largest dimension at admission), the affected sites (single symptoms
lobe versus multilobar) and the types of imaging obtained Fever 32 (82) 25 (78) 7 (22)
were also recorded. The final antibiotic choice was recorded Cough 26 (66) 19 (73) 7 (27)
from discharge summary and/or outpatient clinic follow‑up, Emesis 11 (28) 8 (73) 3 (27)
and duration of therapy was determined by last outpatient Chest pain 9 (23) 7 (78) 2 (22)
clinic note. For patients who required surgical intervention, Upper respiratory 6 (15) 5 (83) 1 (17)
the indications, type of procedures performed, and any Tract infection
complications stemming from the intervention were also Dyspnea 5 (13) 5 (100) 0 (0)
recorded. Resolution status was determined by last pediatric Night sweats 3 (7) 2 (67) 1 (33)
infectious disease outpatient clinic note that documented the Abdominal pain 2 (5) 2 (100) 0 (0)
discontinuation of antibiotics. Diarrhea 2 (5) 1 (50) 1 (50)
Hemoptysis 1 (3) 1 (100) 0 (0)
Statistical analysis
n (% lobe) n (% lobe)
For this descriptive study, the variables assessed (as noted
(medical) (surgical)
above) in the study population are presented as frequencies
Site affected
or percentages of the total. For statistical analysis, we used
Left lower lobe (LLL) 13 (33) 10 (77) (34) 3 (23) (30)
SPSS software (version 19.0, International Business Machines,
Armonk, NY, USA) and utilized the Chi‑square test to compare Right lower lobe (RLL) 10 (26) 6 (60) (21) 4 (40) (40)
clinical variables. P ≤0.05 was determined to be statically Right upper lobe (RUL) 5 (13) 5 (100) (17) 0 (0) (0)
significant. Left upper lobe (LUL) 4 (10) 3 (75) (10) 1 (25) (10)
Bilateral/multilobar 4 (10) 3 (75) (10) 1 (25) (10)
Results Right middle lobe 3 (8) 2 (67) (7) 1 (33) (10)
(RML)
Over the 10‑year period covered in this study, there were Prior antibiotic therapy 15 (38) 11 (73) 4 (26)
874 patients that met the initial inclusion criteria. From chart Neuro = Seizure disorder, developmental delay, cerebral palsy, insomnia,
attention deficit hyperactivity disorder, myotonic dystrophy, hypoxic ischemic
review of each of these individual inpatient encounters, encelaopathy, ventriculoperitoneal shunt; Gastrointestinal = Gastrostomy tube
40 patients were finally identified to have a true lung abscess. fed, gastroschisis, gastroesophageal reflux disease, esophageal stricture,
The remaining 834 charts were not included as there was esophageal diverticulum, Immunodeficiency = Jobs disease, neutropenia;
Cardiac = Cardiac transplant, congenital heart disease, Respiratory = Asthma,
evidence of pneumonia without abscess formation. One patient
recent pneumonia, allergies, recent lung abscess, cyst, respiratory syncytial
had to be excluded because the patient was subsequently virus bronchiolitis, tracheostomy, epistaxis; General = Scoliosis, failure to
found to have an infected teratoma rather than lung abscess. thrive, eczema, extreme prematurity, medical neglect, decubitus ulcer

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Madhani, et al.: Pediatric lung abscess treatment and outcomes

created based on subsequent course – if patients required Table 2: Diagnostic testing, imaging, and microbiology
treatment with intravenous (IV) antibiotics alone, they were results for pediatric patients with lung abscess
allocated in the “medical” sub‑group. However, if they Characteristics Total, n (%) Medical, n (%) Surgical, n (%)
required surgical interventions (chest tube placement, open Cultures obtained
drainage of abscess, or lobectomy), then they were placed None 12 (31) 12 (31) 0 (0)
in the “surgical” sub‑group. The demographic and clinical Sputum 13 (33) 13 (33) 0 (0)
characteristics for our study population are presented in BAL 6 (15) 5 (13) 1 (3)
Table 1. The most common race encountered in our cohort was
Drainage 5 (13) 0 (0) 1 (3)
African American (n = 23, 59%), and also included Caucasian
Chest tube 2 (5) 0 (0) 2 (5)
(n = 9, 23%), Hispanic (n = 4, 10%), Middle Eastern (n = 2, 5%),
Blood 1 (3) 0 (0) 1 (3)
and one patient (n = 1, 11%) for whom race was not specified.
Diagnostic imaging
The average age of patients in this study was 7.6 years, although
ranged from 2 weeks of life to 18 years. Chest X-ray 4 (10) 3 (75) 1 (25)
CT 34 (87) 26 (76) 8 (24)
The most common presenting symptoms were fever Chest US 1 (3) 1 (100) 0 (0)
(n = 32, 82%), cough (n = 26, 66%), and emesis (n = 11, 28%). Microbiology results
Even after categorizing patients into medical and surgical Staphylococcus 5 (13) 4 (80) 1 (20)
groups, we found the most common presenting symptoms MSSA 3 (60) 2 (66) 1 (33)
continued to be fever (medical n = 25, 83%, surgical MRSA 2 (40) 2 (100) 0 (0)
n = 7, 78%), cough (medical n = 19, 63%, surgical n = 7, 78%), Streptococcus 2 (5) 1 (50) 1 (50)
and emesis (medical n = 11, 27%, surgical n = 3, 33%) in both Peptostreptococcus 1 (3) 0 (0) 1 (100)
groups. Eleven of the 39 (28%) patients had no underlying Fusobacterium 1 (3) 0 (0) 1 (100)
medical condition while the most common medical history Polymicrobial 4 (10) 1 (25) 3 (75)
was asthma with 21%. Of note, one patient was found to have None identified 26 (67) 24 (92) 2 (3)
hyperimmunoglobulin E syndrome after the second admission MSSA = Methicillin-sensitive Staphylococcus aureus, MRSA = Methicillin-
for a recurrent lung abscess. Other notable patients included resistant Staphylococcus aureus; CT = Computed tomography; BAL = Bronchial
one patient with each of the following: Post-heart transplant alveolar lavage, US = Ultrasound
on immunosuppressive therapy, extreme prematurity, seizure
disorder, diabetes mellitus type 1, esophageal diverticulum, showed Fusobacterium necrophorum. Of the respiratory
myotonic dystrophy, tracheostomy and gastric tube dependent, cultures obtained, the organisms most commonly identified
and cerebral palsy. Of note, 4 patients had a history of were methicillin‑sensitive S. aureus and methicillin‑resistant
recent pneumonia, as well as one with a history of recurrent S. aureus (MRSA), S. pneumoniae, Streptococcus mitis and
pneumonias. When grouped into categories, the most common Peptostreptococcus. Other organisms obtained included
underlying medical condition was a respiratory disease (n = 12, Achromobacter sp., Aspergillus fumigatus, Moraxella caterhallis,
31%), followed by neurological disease (n = 6, 15%). Prior to Klebsiella sp. (extended spectrum beta‑lactamase producing),
admission, 24 of 39 (62%) patients were not treated with any Enterobacter sp., viridans group streptococci, and Eikenella sp.
antibiotic therapy. Of the remaining 38%, the most common
antibiotic therapy patients received prior to admission was The most common empiric antibiotic combination [Table 3]
amoxicillin (53% of patients who received prior therapy). used for treatment in our cohort of 39 patients was ceftriaxone
with clindamycin (n = 20, 53%). It should be noted that one
The most common location was noted to be the left lower patient was directly started on oral medication, and one
lobe (n = 13, 33%) while the least common site was right middle history and physical could not be reviewed. Some patients
lobe (n = 3, 8%). Of note, there were 4 patients with bilateral or underwent changes in their antibiotic treatment plans based
multilobar lung abscesses. Of the left lower lobe abscess site, on culture results or clinician preferences. The most common
77% were treated medically while 23% were treated surgically. final antibiotic choice was also ceftriaxone with clindamycin
The most common medically treated site was the left lower (n = 23, 59%). Of the 20 patients that were started on ceftriaxone
lobe (n = 10, 34%) while the most common surgically treated site and clindamycin, 18 (90%) were treated medically. IV antibiotic
was right lower lobe (n = 3, 30%). The most common imaging duration had been recorded in 34/39  patients. The average
obtained for confirmation of infection was chest radiograph length of IV treatment was 24.6 days, ranging from 3 days to
followed by computed tomography (CT) of chest (n = 34, 87%). 51 days.
Four patients had chest radiographs alone and 1 patient had
undergone chest ultrasound. There were 9 (23%) patients that underwent operative or
procedural intervention [Table 4]. Interventions included chest
Table 2 outlines the results of the microbiological cultures tube placement (5/9), thoracoscopy with decortication (1/9),
obtained as well as imaging studies. After admission, drainage by interventional radiology (5/9), lobectomy (1/9), and
12 patients did not have any culture results for the identification pigtail catheter placement (1/9). The most common complications
of organisms causing the lung abscess. Sixteen patients had from these interventions were pneumothorax (3/9), followed
sputum cultures; 6 underwent a bronchoalveolar lavage, by chest tube obstruction  (1/5). Of the 39  patients, 31 had a
5 underwent abscess incision and drainage, and 1 had an complete resolution, while 8 were lost to follow‑up.
associated empyema that was drained. Of note, one patient
was admitted with the diagnosis of pyelonephritis and We compared the differences between medical versus surgical
urosepsis and did have a positive blood culture, which patients in relation to fever duration, average abscess size,

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Madhani, et al.: Pediatric lung abscess treatment and outcomes

Table 3: Empiric and final antibiotic therapies used at 6.1 cm (P = 0.002). Medically treated patients had an average
for pediatric patients with lung abscess length of stay 11 days while surgically treated patients were
n=38 Medical (%) Surgical (%) found to have an average stay of 28 days (P = 0.031). Medically
Empiric IV antibiotics treated patients were slightly younger, with an average age of
Ceftriaxone and 20 18 (90) 2 (10) 7 years; while surgically treated patients had an average age
clindamycin of 10 years (P = 0.008). Initial white blood count and CRP did
Ceftriaxone 6 5 (83) 1 (17) not vary significantly between the two groups.
Ceftriaxone and 2 1 (50) 1 (50)
vancomycin Discussion
Ampicillin/sulbactam 2 1 (50) 1 (50)
Ceftriaxone, vancomycin, 2 1 (50) 1 (50) This study was conducted to highlight the epidemiologic
azithromycin profile, clinical presentation, microbiologic spectrum, and
Vancomycin 1 1 (100) 0 (0) pharmacologic management of pediatric patients with
Vancomycin and 1 0 (0) 1 (100) lung abscess at a single institution. While there were not
meropenem enough patients to enable comparisons of outcomes based
Vancomycin and 1 0 (0) 1 (100) on antibiotic regimens that were utilized, it does give some
clindamycin meaningful information about the clinical management of
Ceftriaxone and 1 1 (100) 0 (0) these patients. Assessment of the risk factors for the need for
azithromycin surgical intervention further helps in treatment decisions
Ceftriaxone and 1 0 (0) 1 (100) given that children with longer duration of fever and
metronidazole larger size of the abscess are more likely to require surgical
Final IV antibiotics intervention.
Ceftriaxone and 23 21 (91) 2 (9)
clindamycin There have been few case series of pediatric lung abscesses
Ampicillin/sulbactam 4 3 (75) 1 (25) previously published,[4,5,7,8] but there have been no reports since
Clindamycin 2 2 (100) 0 (0) 2005.[2,5] The most common presenting signs and symptoms
Vancomycin, 1 0 (0) 1 (100) reported in these studies included the fever, cough, and
meropenem, voriconazole dyspnea.[1,2,4,5] Most previous case series have reported the
Vancomycin 1 1 (100) 0 (0) right lung to be the most commonly affected side.[1‑4] There are
Vancomycin, clindamycin, 1 0 (0) 1 (100)
additional reports about surgical treatment of pediatric lung
ceftriaxone abscesses[9,10] and some recent publications have highlighted
Ceftriaxone 1 1 (100) 0 (0) the fact that the treatment approach is now shifting toward
the use of less invasive procedures, such as CT‑guided needle
Meropenem 1 0 (0) 1 (100)
aspiration[11] or thoracoscopic resection[12] in cases that are
Meropenem, vancomycin 1 0 (0) 1 (100)
refractory to medical therapy. The overall treatment outcomes
Ceftriaxone, vancomycin, 1 0 (0) 1 (100)
and incidence of complications in pediatric patients with lung
metronidazole
abscess still remains poorly defined.
Azithromycin, 1 0 (0) 1 (100)
vancomycin, ceftriaxone
In our study, we found that fever and cough were the most
Amoxicillin/clavulanic acid 1 1 (100) 0 (0)
common presenting symptoms. This was also demonstrated
Clindamycin, cefepime 1 1 (100) 0 (0)
in previous studies.[1,5,8] Puligandla and Laberge reported that
IV = Intravenous
tachypnea, cough, and fever were the most common symptoms,
and may develop over weeks.[3] Emesis and chest pain were the
Table 4: Surgical interventions and their outcomes third and fourth most common symptoms in our cohort, and
Surgical intervention n=9 Chan et al. also reported similar rates of chest pain among their
Chest tube 5 cohort.[5] The most common site of involvement of lung varies
Open drainage 5 between studies. We found the most common location to be left
Lobectomy 1 lower lobe while other studies have reported right upper lobe[5]
Pigtail catheter 1 and right lower lobe[1] to be the most common sites. Another
Thoracoscopy and 1 study found lung abscess secondary to aspiration to be more
decortication prevalent.[6] One study found that lung abscess developed on
Complications n=4 the right side greater than left,[1] which was consistent with
Pneumothorax 3
our overall results (18 right sided vs. 17 left sided). We also
had four patients with bilateral lung abscess, which has rarely
Chest tube obstruction 1
been reported in literature.[13] Imaging plays an important role
in diagnosis and management. Stark reported that the ideal
average length of stay, average age, average white blood cell, method to image a suspected lung abscess is via CT scan[14] and
and average C‑reactive protein (CRP) [Table 5]. Medically majority of our patients did undergo a chest CT for establishing
treated patients were found to have an average fever the diagnosis and for treatment planning.
duration of 11 days compared to surgically treated patients at
28 days (P = 0.004). Medically treated patients had an average We found that Staphylococcus spp. and Streptococcus spp. were
abscess size of 4.4 cm compared to surgically treated patients the most common single pathogens, which correlates with

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Madhani, et al.: Pediatric lung abscess treatment and outcomes

Table 5: Statistical analysis of risk factors for need between centers. At CHM, approximately 90% of all our
for surgical intervention in pediatric patients with S. aureus isolates retained susceptibility to clindamycin
lung abscess during the study period.
Medical (SD) Surgical (SD) P
Fever duration (days) 11 28 0.004 Surgical intervention is not commonly required for the
Average abscess size (cm) 4.4 (±1.9) 6.1 (±3.7) 0.002 management of pediatric lung abscess. We found only
Average WBC (k/cumm) 17 23 0.211 9 cases in a 10 year period that required surgical intervention
Average CRP (mg/L) 97 41 0.276 while another study reported it for 21 cases over a period
Average length of stay (days) 11 28 0.031
of 25 years.[10] There are reports giving some guidance as to
when surgical intervention is necessary. One instance states
Average age (years) 7 10 0.008
SD = Standard deviation; CRP = C-reactive protein; WBC = White blood cells
that if a patient cannot provide an adequate cough and is
failing medical management, surgical intervention may
be necessary.[8] There are many different types of surgical
previously reported studies.[1,5] Macdonald goes as far as intervention. Wong recommends that early ultrasound‑guided
stating that S. pneumoniae was the preantibiotic era pathogen percutaneous aspiration be attempted in peripherally located
while now the most common pathogen is Staphylococcus or abscesses as this can be diagnostic and therapeutic.[17] Cuestas
polymicrobial anaerobic bacteria,[15] which is also consistent in argues that to optimize percutaneous drainage, the abscess
our study data. Brook and Finegold also gave emphasis to how should be verified to be an abscess (preferably by obtaining
the microbiological cultures are obtained, stating that unless
cross‑sectional imaging), and be peripherally located. [18]
the cultures were obtained by bypassing the oropharynx, the
Previously reported risk factors that can lead to need for
test result could not be verified.[6] In their study, they were
surgical intervention are inadequate antimicrobial coverage
able to find both aerobic and anaerobic bacteria group  A
and anatomical malformations.[10]
beta‑hemolytic Streptococcus and Peptostreptococci, respectively.
Emanuel and Shulman had reported 18 cases with primary
As in our study, while initial concerns for lung abscess are
lung abscess, of which one was found to have S. pneumoniae
valid, they are not always easy to detect. One patient in
while the rest had bacteria from the upper respiratory tract
our study, who was excluded, was initially treated as lung
or of uncertain significance.[1] Tan found that 27% of isolates
abscess until he was found to have an infected cyst, and
were anaerobes.[2] Puligandla and Laberge found Streptococcus,
then subsequently diagnosed as teratoma in the anterior
anaerobic species, S. aureus, and Klebsiella to be the most
mediastinum. There are case reports of congenital cystic
common pathogens in their study.[3] It would seem through
adenomatoid malformation presenting as a lung abscess.[19,20]
the results of these studies that antibiotic coverage for both
In another case report, an adolescent male with a history of
Streptococcus and Staphylococcus is imperative, along with
acute lymphoblastic leukemia was admitted for sepsis and
anaerobic coverage. The specimen collection method is also
very important, as sputum culture seems to provide little or initial radiographic studies showed features concerning
no help in clinical decision‑making and is difficult to obtain in for pulmonary aspergilloma. After enucleation of the mass
the majority of the pediatric patients. and cavity was performed, the patient was found to have
Pseudomonas sp. lung abscess.[21]
Our study found that mean duration of therapy with IV
antibiotics was 24 days. In another study, the mean duration There are several limitations of this study, which include its
of antibiotic therapy separated into primary versus secondary retrospective nature, it being limited to a single center and
lung abscess, was found to be 28 and 45 days, respectively.[5] the lack of follow‑up data for some of the patients. Due to
Brook and Finegold found that patients were treated for an the transition from paper charts to electronic medical records
average of 30 days.[6] When choosing antimicrobials, Tan et al. at our institution in the mid‑2000s and the variability in
recommended selection based on the clinical situation, stating documentation, there were some difficulties in obtaining
that it should include a penicillinase‑resistant agent and complete records for all the inpatients. Another limitation of
clindamycin,[2] which was consistent with our study findings. this study is the paucity of culture data and the organisms
Puligandla and Laberge recommended using penicillins identified. There was a wide array of antibiotic regimens used
as the first line but warned that beta‑lactam resistance with limited number of patients per group, which limited our
can be problematic. This author also states that adding statistical analysis.
clindamycin for S. aureus can help to overcome this, along
with a third generation cephalosporin.[3] Similarly, Holston Conclusion
et al. recommended adding a third generation cephalosporin
if clindamycin is used. [16] Given that S. pneumoniae and To conclude, pediatric lung abscesses are likely polymicrobial
S. aureus are the likely pathogens, a reasonable option of and frequently include Staphylococcus and Streptococcus
initial antibiotic choice can be ceftriaxone combined with spp. along with oral anaerobes. Surgical intervention is
clindamycin. In our study, this was the most common not required for majority of the cases, but the presence of
antibiotic of choice to result in resolution of the lung abscess. prolonged fever and large abscess size may help predict the
Of note, while we did find cases of MRSA, most patients need for surgical intervention. However, optimal selection
in our study did not have an identifiable organism as no and duration of antimicrobial therapy are still not clearly
culture was obtained, or cultures only showed normal oral defined. Larger studies are needed to address the questions
flora. This choice of antibiotics in our cohort may reflect of appropriate empiric antibiotic selection and duration of
institutional preference and antibiotic regimens can vary therapy.

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Madhani, et al.: Pediatric lung abscess treatment and outcomes

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Nil. neonatal lung abscesses. Pediatr Radiol 1991;21:254‑7.
12. Garrido‑Pérez JI, Lasso‑Betancor CE, Escassi‑Gil Á. Thoracoscopic
Conflicts of interest treatment of pediatric lung abscess. Arch Bronconeumol
2012;48:382‑3.
There are no conflicts of interest.
13. Kulkarni K, Bakshi AS, Jerath N. Bilateral lung abscesses
in a 9‑month‑old healthy infant. BMJ Case Rep 2010;2010.
References pii: Bcr06.2009.2046.
14. Stark DD, Federle MP, Goodman PC, Podrasky AE, Webb WR.
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196 Annals of Thoracic Medicine ‑ Vol 11, Issue 3, July‑September 2016