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Updated: Jul 24, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
The value of a CT-guided fine needle aspirate in infants with lung abscess
J Levison1, P Van Asperen, C Wong
1The Grace Centre for Newborn Care, The Children's Hospital at Westmead, Syndey, New South Wales, Australia. john.levison@email.cs.nsw.gov.au
Insights
Directly culturing lung abscesses in infants can identify pathogens like Pseudomonas aeruginosa and Staphylococcus aureus, guiding effective antibiotic treatment. This approach avoids mortality and recurrence in young children.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Neonatal Care
Background:
- Lung abscesses are rare in infants, with limited data on causative pathogens and optimal diagnostic strategies.
- Understanding predisposing factors such as prematurity, assisted ventilation, and congenital lung anomalies is crucial.
Observation:
- A review of infants diagnosed with lung abscess between 1989 and 2002 identified five cases under one year of age.
- Congenital cystic adenomatoid malformation was noted in one case of left-sided lung abscess.
- Direct abscess culture successfully identified pathogens in four out of five infants.
Findings:
- Commonly isolated pathogens included Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae.
- One case involved a polymicrobial infection with Escherichia coli, Streptococcus milleri, and Propionibacterium species.
- Targeted antibiotic therapy based on culture results led to successful outcomes without mortality or recurrence.
Implications:
- CT-guided fine needle aspiration for direct abscess culture is recommended for peripheral abscesses in infants.
- Accurate pathogen identification enables appropriate intravenous medical therapy, improving patient outcomes.
- This diagnostic approach is vital for managing lung abscesses in the pediatric population.
Objective:
To describe the range of pathogens isolated from a lung abscess in infants less than one year of age. To assess the role of direct culture from the abscess.
Methods:
The two index cases were managed in 2002. An institution-based review was conducted of all infants up to one year of age diagnosed with a lung abscess between 1989 and 2002. Data sources were hospital's disease index and Neonatal Intensive Care Unit Audit database using ICD9 and ICD10 diagnostic codes for 'lung abscess'.
Results:
Five infants, under the age of one year, were treated for a lung abscess. In the one case where the abscess was left-sided it was associated with a congenital cystic adenomatoid malformation of the lung. Pathogens were isolated following direct culture of the abscess in four cases. In three cases a single pathogen was isolated: pseudomonas aeruginosa, staphylococcus aureus and haemophilus influenzae. In one case a mixture of escherichia coli, streptococcus milleri and an anaerobe, propionibacteria, were cultured. Antibiotic therapy was directed at the identified pathogen(s) in all four cases. There was no mortality or recurrence.
Conclusion:
Predisposing factors for a lung abscess in infancy include prematurity, assisted ventilation, congenital lung anomaly and aspiration. Given the range of potential pathogens, direct culture by CT-guided fine needle aspiration is recommended to direct appropriate intravenous medical therapy provided the abscess is located peripherally.
