Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer M R
Division of Medicine, Hadassah University Hospital, Hebrew University Medical School, Jerusalem, Israel.
Chest. 1999 Mar;115(3):746-50. doi: 10.1378/chest.115.3.746.
The rates of morbidity and mortality associated with lung abscess are still significant despite the introduction of antibiotic treatments. The aim of this work was to identify the factors that predict a poor outcome for patients with lung abscess.
We retrospectively reviewed the records and the roentgenographic files of adult patients with lung abscess who were hospitalized from 1980 to 1996 at the Hadassah University Hospital, in Jerusalem, Israel.
The study population comprised 75 patients, and the mean age was 52 years old (range, 12 to 89 years). The mean (+/- SD) hospitalization duration was 25.7+/-21.5 days (range, 5 to 94 days). Fifteen patients (20%) succumbed to the infection. The patients who died had more predisposing factors (+/-SD), such as pneumonia, neoplasm, and altered consciousness, than those who survived, respectively: 2.73+/-1.4 vs 1.9+/-1.3 (p < 0.03). The patients with anemia on admission (hemoglobin levels of < 10 g/dL) had a higher mortality rate than those with higher hemoglobin levels, respectively: 58.3 vs 12.9% (p = 0.0008). A higher mortality rate was also associated with infection by Pseudomonas aeruginosa (83%), Staphylococcus aureus (50%), and Klebsiella pneumoniae (44%). The patients who died had larger abscess volumes (+/-SD) than those who survived (233+/-99 vs 157+/-33 mL), although it did not reach statistical significance. The diameter of the abscess correlated with the hospitalization time (r = 0.5; p < 0.001).
High rates of morbidity and mortality are associated with lung abscess despite appropriate antibiotic therapy and better supportive care. In patients with several predisposing factors, such as a large abscess size and a right-lower-lobe location, the prognosis was worse. The patients infected with S aureus, K pneumoniae, and particularly P aeruginosa had an ominous prognosis. As the prognosis for lung abscess has not improved sufficiently since the introduction of antibiotics, other modalities should be considered for patients with poor prognostic signs.
尽管引入了抗生素治疗，但肺脓肿相关的发病率和死亡率仍然很高。这项研究的目的是确定预测肺脓肿患者预后不良的因素。
我们回顾性分析了1980年至1996年在以色列耶路撒冷哈达萨大学医院住院的成年肺脓肿患者的病历和X光片档案。
研究人群包括75例患者，平均年龄为52岁（范围12至89岁）。平均（±标准差）住院时间为25.7±21.5天（范围5至94天）。15例患者（20%）死于感染。死亡患者比存活患者有更多的易感因素（±标准差），如肺炎、肿瘤和意识改变，分别为：2.73±1.4 对1.9±1.3（p<0.03）。入院时贫血（血红蛋白水平<10g/dL）的患者死亡率高于血红蛋白水平较高的患者，分别为：58.3%对12.9%（p=0.0008）。较高的死亡率还与铜绿假单胞菌（83%）、金黄色葡萄球菌（50%）和肺炎克雷伯菌（44%）感染有关。死亡患者的脓肿体积（±标准差）大于存活患者（233±99对157±33mL），尽管未达到统计学意义。脓肿直径与住院时间相关（r=0.5；p<0.001）。
尽管有适当的抗生素治疗和更好的支持治疗，肺脓肿的发病率和死亡率仍然很高。在有多种易感因素的患者中，如脓肿较大和位于右下叶，预后较差。感染金黄色葡萄球菌、肺炎克雷伯菌尤其是铜绿假单胞菌的患者预后不良。由于自引入抗生素以来肺脓肿的预后改善不足，对于预后不良体征的患者应考虑其他治疗方式。
