Treatment management of patients with lung abscess: a retrospective cohort study

Lung abscesses (LAs) are severe respiratory infections characterised by necrosis of pulmonary tissue. Despite the need for long-term antibiotic treatment, evidence on optimal treatment is limited, and no international guidelines exist. We aimed to evaluate different treatment strategies for treating LAs.

Patients hospitalised from 2016 to 2021 with LA were included in a retrospective multicentre cohort study. Descriptive statistics were presented for the current treatment strategies of LA regarding the choice and duration of antibiotic treatment, as well as the use of interventional treatments and associated treatment outcomes.

In 222 patients diagnosed with LA, 89.2% were treated with intravenous antibiotics for a median duration of 14 days, followed by oral antibiotics for a median of 26 days; 10.8% received oral antibiotics as first-line therapy. Duration of intravenous treatment, total length of antibiotic treatment, and occurrence of treatment failure did not differ across the four most used antibiotic regimens: Benzylpenicillin and metronidazole, piperacillin/tazobactam with or without metronidazole, cefuroxime and metronidazole, or clindamycin monotherapy. Duration of hospitalisation varied slightly between treatment groups, with a trend of the shortest length of stay for patients treated with clindamycin. Fifteen patients underwent interventional treatment. These patients were characterised by larger abscesses, longer duration of antibiotic treatment, and higher mortality.

Within the limitations of a descriptive design, no significant differences in clinical outcomes of LA were observed across the four most common antibiotic regimens. The selection of regimens varied considerably between the four study sites. Randomised studies are urgently needed to guide the best treatment choice.