Lung Abscess Caused by Pseudomonas aeruginosa after a Near-drowning Episode

Area of Science:

• Pulmonology
• Infectious Diseases
• Emergency Medicine

Background:

• Aspiration pneumonia, termed drowning-associated pneumonia (DAP), is a severe complication of near-drowning.
• Pathogens in inhaled water, often Gram-negative bacilli, differ from community-acquired pneumonia causes.
• DAP requires specific diagnostic and therapeutic considerations distinct from typical pneumonia.

Purpose of the Study:

• To report a case of a patient who developed a lung abscess secondary to drowning-associated pneumonia.
• To highlight the importance of considering specific pathogens, such as Pseudomonas aeruginosa, in DAP.
• To emphasize the need for appropriate empirical antibiotic coverage in near-drowning patients.

Main Methods:

• Case presentation of an 83-year-old male with chronic kidney disease following a near-drowning event.
• Initiation of high-flow nasal cannula therapy for respiratory distress.
• Diagnostic workup including chest CT and sputum culture, followed by targeted antibiotic therapy.

Main Results:

• The patient developed a lung abscess despite initial treatment, with sputum culture identifying Pseudomonas aeruginosa.
• Treatment with cefepime led to fever resolution and CT-confirmed improvement of the lung abscess.
• Antibiotic adjustment was necessary due to suspected drug-induced kidney injury, with moxifloxacin used for discharge.

Conclusions:

• Clinicians must assess the risk of pneumonia and identify likely pathogens after macroaspiration events.
• Empirical antibiotic coverage for Gram-negative organisms, including P. aeruginosa, should be considered in patients with pneumonia post-near-drowning.
• Prompt and targeted antimicrobial therapy is essential for managing DAP and its complications like lung abscesses.