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Title: Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation

Abstract

IntroductionLung 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.Materials and MethodsRetrospective 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).ResultsTechnical 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).ConclusionIn cases of persistent lung abscess after broad-spectrum antibiotics, percutaneous abscess drainagemore » 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.« less

Authors:
; ; ;  [1]
  1. Hospital of the University of Pennsylvania, Perelman School of Medicine, Division of Interventional Radiology, Department of Radiology (United States)
Publication Date:
OSTI Identifier:
22645164
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 6; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABSCESSES; ANTIBIOTICS; BLOOD; CORRELATIONS; DEATH; DRAINAGE; FAILURES; GROWTH; HOSPITALS; LUNGS; MORTALITY; PATHOLOGY; PATIENTS; RESOLUTION; REVIEWS; THERAPY

Citation Formats

Duncan, Christopher, Nadolski, Gregory J., Gade, Terence, and Hunt, Stephen, E-mail: Stephen.hunt@uphs.upenn.edu. Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation. United States: N. p., 2017. Web. doi:10.1007/S00270-017-1623-3.
Duncan, Christopher, Nadolski, Gregory J., Gade, Terence, & Hunt, Stephen, E-mail: Stephen.hunt@uphs.upenn.edu. Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation. United States. doi:10.1007/S00270-017-1623-3.
Duncan, Christopher, Nadolski, Gregory J., Gade, Terence, and Hunt, Stephen, E-mail: Stephen.hunt@uphs.upenn.edu. Thu . "Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation". United States. doi:10.1007/S00270-017-1623-3.
@article{osti_22645164,
title = {Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation},
author = {Duncan, Christopher and Nadolski, Gregory J. and Gade, Terence and Hunt, Stephen, E-mail: Stephen.hunt@uphs.upenn.edu},
abstractNote = {IntroductionLung 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.Materials and MethodsRetrospective 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).ResultsTechnical 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).ConclusionIn 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.},
doi = {10.1007/S00270-017-1623-3},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 40,
place = {United States},
year = {Thu Jun 15 00:00:00 EDT 2017},
month = {Thu Jun 15 00:00:00 EDT 2017}
}
  • Purpose: Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures.Methods: Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and post interventional drainage periods were analyzed.Results: When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 {+-} 3.7 min versus 14.8 {+-} 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to bemore » revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, post interventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test).Conclusion: Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and post interventional drainage periods.« less
  • No abstract prepared.
  • Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The followingmore » pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V{sub 22} (volume of lung exposed to a radiation dose ≥22 Gy) and V{sub 30} (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and V{sub dose} (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed dose should be used to perform risk stratification of patients receiving lung irradiation.« less
  • Objective: To investigate the prognostic significance of image gradients and in predicting clinical outcomes in a patients with non-small cell lung cancer treated with stereotactic body radiotherapy (SBRT) on 71 patients with 83 treated lesions. Methods: The records of patients treated with lung SBRT were retrospectively reviewed. When applicable, SBRT target volumes were modified to exclude any overlap with pleura, chestwall, or mediastinum. The ITK software package was utilized to generate quantitative measures of image intensity, inhomogeneity, shape morphology and first and second-order CT textures. Multivariate and univariate models containing CT features were generated to assess associations with clinicopathologic factors.more » Results: On univariate analysis, tumor size (HR 0.54, p=0.045) sumHU (HR 0.31, p=0.044) and short run grey level emphasis STD (HR 0.22, p=0.019) were associated with regional failure-free survival; meanHU (HR 0.30, p=0.035), long run emphasis (HR 0.21, p=0.011) and long run low grey level emphasis (HR 0.14, p=0.005) was associated with distant failure-free survival (DFFS). No features were significant on multivariate modeling however long run low grey level emphasis had a hazard ratio of 0.12 (p=0.061) for DFFS. Adenocarcinoma and squamous cell carcinoma differed with respect to long run emphasis STD (p=0.024), short run low grey level emphasis STD (p<0.001), and long run low grey level emphasis STD (p=0.024). Multivariate modeling of texture features associated with tumor histology was used to estimate histologies of 18 lesions treated without histologic confirmation. Of these, MVA suggested the same histology as a prior metachronous lung malignancy in 3/7 patients. Conclusion: Extracting radiomics features on clinical datasets was feasible with the ITK package with minimal effort to identify pre-treatment quantitative CT features with prognostic factors for distant control after lung SBRT.« less
  • Co-infections involving porcine reproductive and respiratory syndrome virus (PRRSV) and porcine circovirus type 2 (PCV2) are common and contribute to a range of polymicrobial disease syndromes in swine and on a world-wide basis. Both viruses compromise host defenses, resulting in increased susceptibility to infections by primary and secondary pathogens that can affect growth performance as well as increased morbidity and mortality. An experimental population of 95 pigs was co-infected with PRRSV and PCV2. At 70 days post-infection (dpi), 20 representative pigs were selected as having the best or worst clinical outcome based on average daily gain (ADG) and the presencemore » of clinical disease. Moreover, the worst clinical outcome pigs had prolonged and greater levels of viremia as measured by qPCR. Serum, lung and fecal samples collected at 70 dpi were analyzed using a comprehensive DNA microarray technology, the Lawrence Livermore Microbial Detection Array, to detect over 8000 microbes. Bacterial species, such as Bacillus cereus, were detected at a higher rate in the serum of worst performing pigs. At the level of the fecal microbiome, the overall microbial diversity was lower in the worst clinical outcome group. The results reinforce the importance of pathogen load in determining clinical outcome and suggest an important role of microbial diversity as a contributing factor in disease.« less