Percutaneous transthoracic needle aspiration, lavage and instillation of clindamycin–gentamycin in peripheral pyogenic lung abscess

Abstract

Background: Lung abscess are defined as localized suppurative necrotizing collection occurring within the pulmonary parenchyma. Some authors emphasized image-guided aspiration of lung abscess before antibiotics use in order to identify the pathogen. Antibiotic lavage is currently widely used in the treatment of patients with peritonitis, but not used previously in lung abscesses. Aim of the study: Is to asses the role of percutaneous transthoracic needle aspiration, lavage and instillation of clindamycin–gentamycin on the treatment of peripheral pyogenic lung abscess. Materials and methods: Twenty-six patients with peripheral pyogenic lung abscess are included in this study and classified into two groups. Group I received systemic empirical antibiotic, remodulated after the result of sputum culture and sensitivity. While group II underwent ultrasound guided percutaneous transthoracic needle aspiration, lavage and local instillation of antibiotics (clindamycin–gentamycin) associated with receiving systemic empirical parentral antibiotics, that were remodulated after the result of aspiration culture and sensitivity. Chest X-ray and chest ultrasound were done pre, post and after intervention by one week and before discharge. Results: There was a statistically significant difference between group I and II as regard duration of systemic antibiotic use, duration of hospital stay, duration of radiological improvement, and size of abscess after intervention. Moreover complications occurred in group I were higher than in group II. Succeeded patients (according to clinical and radiological improvement of lung abscess) were more obvious among group II than group I. Aspirates culture and sensitivity revealed gram negative bacteria and anaerobic microorganisms, which are sensitive to local instillation of antibiotics (clindamycin–gentamycin). Conclusion: Percutaneous aspiration of peripheral lung abscess has an accurate determination of the causative organisms inside the abscess. The resolution of the abscesses clinically and radiologically was hastened by needle aspiration, lavage and instillation of clindamycin–gentamycin. Early intervention can improve symptoms, decrease morbidity and complications.

Keywords

• Percutaneous transthoracic needle aspiration
• Lavage
• Instillation of clindamycin–gentamycin
• Peripheral pyogenic lung abscess