Monteiro Rita, Alfaro Tiago M, Correia Lurdes, Simão Adélia, Carvalho Armando, Costa J Nascimento
Serviço de Medicina III, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:229-40. Epub 2011 Dec 31.
Lung abscess is a collection of necrotic and suppurated tissue located at the pulmonary parenchyma. Empyema is defined as the presence of pus in the pleural space.
To study the clinical and microbiological characteristics, treatment and prognosis of patients with lung abscess and/or empyema admitted to an Internal Medicine ward.
A retrospective analysis of medical records was performed, including all patients admitted to an Internal Medicine ward for lung abscess or empyema, between 2000 and 2008.
Thirty patients were included (22 males/ eight females), accounting for 0.18% of all patients admitted in this ward in the same period. Three patients had pulmonary abscess, 18 empyema, and nine both diseases. The average age was 68.5 years (31 to 90). The most frequent complaints were dyspnoea (90%), fever (73.3%), cough (66.7%), weight loss (60%) and chest pain (53.3%). The most frequent associated disorders were stroke associated disability (46.7%), heart failure (43.3%) and arterial hypertension (33.3%). Thoracentesis was performed in all patients with empyema. In one patient with lung abscess an anaerobic microorganism was identified. In patients with empyema, cultures were positive in 61.1% of cases, with a slight predominance of methicillin-resistant Staphylococcus aureus (27.3%) and Prevotella intermedia (18.2%). In patients with both abscess and empyema, cultures of the abscess were positive in 44.4% and of the pleural fluid in 33.3%, with no predominant microorganism. Empiric antimicrobial therapy was started in all patients and later adapted to the antibiotic sensitivity test results. Surgery was performed in three patients. Seven patients (23.3%) died during admission. The average age of the patients who died was 81.3 years and of those who survived was 64.5 years.
Lung abscess and empyema are infrequent diseases in an Internal Medicine ward, affect mostly males and have unspecific clinical manifestations. The chest X-ray, computed tomography (CT) and thoracentesis were the main diagnostic tests. Most cultures were negative. Medical treatment was the most frequent choice, with surgery being used in 10% of cases. Older age and multiple associated conditions were associated with a worse prognosis.
肺脓肿是位于肺实质的坏死和化脓组织的聚集。脓胸定义为胸膜腔内存在脓液。
研究内科病房收治的肺脓肿和/或脓胸患者的临床和微生物学特征、治疗及预后。
对2000年至2008年期间内科病房收治的所有肺脓肿或脓胸患者的病历进行回顾性分析。
纳入30例患者（22例男性/8例女性），占同期该病房收治患者总数的0.18%。3例患有肺脓肿，18例患有脓胸，9例同时患有这两种疾病。平均年龄为68.5岁（31至90岁）。最常见的主诉是呼吸困难（90%）、发热（73.3%）、咳嗽（66.7%）、体重减轻（60%）和胸痛（53.3%）。最常见的相关疾病是中风相关残疾（46.7%）、心力衰竭（43.3%）和动脉高血压（33.3%）。所有脓胸患者均进行了胸腔穿刺术。1例肺脓肿患者鉴定出厌氧微生物。脓胸患者中，61.1%的病例培养结果呈阳性，耐甲氧西林金黄色葡萄球菌（27.3%）和中间普雷沃菌（18.2%）略占优势。同时患有脓肿和脓胸的患者中，脓肿培养阳性率为44.4%，胸腔积液培养阳性率为33.3%，无优势微生物。所有患者均开始经验性抗菌治疗，随后根据抗生素敏感性试验结果进行调整。3例患者接受了手术。7例患者（23.3%）在住院期间死亡。死亡患者的平均年龄为81.3岁，存活患者的平均年龄为64.5岁。
肺脓肿和脓胸在内科病房中并不常见，主要影响男性，临床表现不具特异性。胸部X线、计算机断层扫描（CT）和胸腔穿刺术是主要的诊断检查。大多数培养结果为阴性。内科治疗是最常见的选择，10%的病例采用了手术治疗。年龄较大和多种相关疾病与较差的预后相关。
