Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.
Department of Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2022 Jul;92(7-8):1850-1855. doi: 10.1111/ans.17844. Epub 2022 Jun 9.
Lung abscess is a rare condition in paediatrics with a paucity of literature. Intravenous antibiotics is the main therapy; however interventional radiological approaches have led to the use of percutaneous drainage. Surgery is reserved for the management of complications. The aim of this study was to describe lung abscess in a cohort of paediatric patients' and determine associations between factors at presentation and outcomes.
A 14-year retrospective cohort study was conducted including all children who presented to a tertiary paediatric hospital in Western Australia with lung abscess. Clinical characteristics, laboratory and radiologic findings, management options and clinical outcomes were examined.
Sixty-eight patients (median age 3.6 (0.08-17.6) years; 44.1% female) were identified to have a lung abscess, with 81% being primary lung abscess. Staphylococcus aureus (including MRSA) and Streptococcus pneumoniae were the most common organisms identified, with S. aureus being most common in Aboriginal patients (80%). A total of 25 antibiotics were prescribed on initiation of treatment in over 20 combinations. 44.9% of patients had complications and hospitalization was prolonged. Patients with S. aureus had longer hospitalization (20.5 days (3-67) than those without (median 13 days (3-52), p = 0.04). There were no associations between factors at presentation and subsequent outcomes. Factors at presentation were not associated with outcomes.
There is unwarranted variation in management of paediatric lung abscess and high complication rates. There is a need for collaboration and clinical practice guidelines to standardize care for lung abscess in children.
肺脓肿在儿科中较为罕见，相关文献较少。静脉内应用抗生素是主要的治疗方法；然而，介入放射学方法已导致经皮引流的应用。手术保留用于并发症的处理。本研究旨在描述儿科患者肺脓肿的情况，并确定就诊时的各种因素与结局之间的关联。
对 14 年来在西澳大利亚一家三级儿科医院就诊的所有肺脓肿患儿进行了回顾性队列研究。检查了临床特征、实验室和影像学发现、治疗选择和临床结局。
共确定 68 例（中位年龄 3.6（0.08-17.6）岁；44.1%为女性）患有肺脓肿，其中 81%为原发性肺脓肿。金黄色葡萄球菌（包括耐甲氧西林金黄色葡萄球菌）和肺炎链球菌是最常见的病原体，而在原住民患者中最常见的病原体是金黄色葡萄球菌（80%）。在 20 多种组合中，开始治疗时共开具了 25 种抗生素。44.9%的患者出现并发症，住院时间延长。金黄色葡萄球菌感染患者的住院时间（20.5 天（3-67）长于无金黄色葡萄球菌感染患者（中位住院时间 13 天（3-52），p=0.04）。就诊时的各种因素与后续结局之间无关联。就诊时的各种因素与结局之间无关联。
儿童肺脓肿的管理存在不必要的差异，且并发症发生率较高。需要协作并制定临床实践指南，以规范儿童肺脓肿的治疗。
