Chapter 66: Lung Empyema and Abscess

Question 1

When to suspect empyema?

Answer 1

If symptoms of pneumonia do not resolve with antibiotic therapy

Question 2

How to diagnosie empyema?

Answer 2

Thoracentesis fluid with a positive Gram stain or culture, pleural fluid glucose <40 milligrams/dL, pH <7.2, or lactate dehydrogenase >1000 IU/L

Question 3

The definitive treatment for empyema

Answer 3

Drainage and antibiotics

Question 4

Most antibiotics have adequate penetration into the pleural space with the exception of the?

Answer 4

Aminoglycosides

Question 5

Drug that can improve drainage of loculated parapneumonic effusions and empyemas

Answer 5

Fibrinolytics

Question 6

The major cause of lung abscess

Answer 6

Type 3 Strep- tococcus pneumoniae and S. aureus. Klebsiella increasing

Question 7

The mortality rate in secondary lung abscess is often?

Answer 7

> 50%

Question 8

Lung abscesses present for ___ are termed acute, and those present for ___ are chronic.

Answer 8

Lung abscesses present for <1 month are termed acute, and those present for >1 month are chronic.

Question 9

When to think if patient has lung abscess?

Answer 9

When its multiple. Think of endocarditis

Question 10

Reasons for Medical Treatment Failure in Lung Abscess

Answer 10

• Bronchial obstruction: neoplasm, foreign body
• Nonbacterial cause: neoplasm, fungi, vasculitis, pulmonary sequestration
• Large cavity size: >6 cm diameter
• Empyema
• Mycobacteria

Question 11

Antibiotic for lung abscess

Answer 11

Ampicillin-Sulbactam 3g IV Q6 or Carbaoenem

Question 12

If antibiotic is unsuccesfull what can you do in patient with lung abscess

Answer 12

• Percutaneous or transbronchial drainage or open drainage of the abscess cavity

Question 13

Procedure for lung abscess that has complication of possible contamination of the unaffected lung

Answer 13

Transbronchial drainage