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Internal Medicine

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84 years old male with past medical history of COPD, hypertension, hyperlipidemia, prediabetes, left total hip arthroplasty 2015, prostate cancer s/p hormone/XRT, and prostate surgery complicated by DVT 2008. Patient recently had influenza infection and presented to ED on 2/14/2024 with a chief complaint of shortness of breath that has been gradually worsening for 3 weeks. His O2 saturation was in the high 80s, and he was placed on 2L NC on arrival to ED, which was transitioned to continuous BiPAP.

 

In the ED, vitals were as follows: Temp 36.9 °C (98.5 °F), HR 107, BP 107/65, RR 20, Sat 98 % on Nasal cannula. CMP was remarkable for glucose 143, albumin 3.0, total protein 6.2. CBC was remarkable for WBC 31.20, Hgb 9.3, HCT 29.3. Other notable labs: BNP 153, troponin 31.


CXR shows left upper lobe infiltrated with possible necrotizing process.

CTA of the chest ruled out pulmonary embolism and confirmed a consolidative process with air bronchogram in the left upper lobe associated with a cavitary lesion and air-fluid level.



Sputum gram stain and culture, fungal stains and cultures, AFB stain and cultures, and blood cultures were obtained and still pending.


In terms of bacteriology of bacteriology of lung abscess, what are the predominant isolates encountered:


Which of the following organisms is more likely to be causing his lung abscess?

  • 0%Klebsiella pneumoniae

  • 0%Staphylococcus aureus

  • 0%Anaerobes (Peptostreptococcus, Prevotella, or Fusobacterium)

  • 0%Streptococcus species (anginosus or mitis)

You can vote for more than one answer.


The patient was started on IV antibiotics and you have been consulted to evaluate the optimal approach for managing the lung abscess,


How would you manage this lung abscess?

  • 0%Immediate abscess drainage or surgical resection

  • 0%Medical therapy with antibiotics and reassess in 7-10 days


What empiric antibiotic regimen would you choose for this patient, please share your thoughts in comment section of this post.


S U

If patients don't respond to antibiotics, drainage of the abscess is needed. Percutaneous transthoracic drainage is preferred for its simplicity and lower risk of spreading infection compared to transbronchial catheter drainage. Surgery is a last resort, only for abscesses that can't be drained or don't improve with less invasive methods.

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