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Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections

BACKGROUND: Necrotizing pneumonia and lung gangrene represent a continuum of severe lung infection. Traditionally, severe cases have been referred for surgical debridement. However, this has been linked to high mortality. Some groups have published encouraging results using a conservative medical ap...

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Autores principales: Larose, Jean-Christophe, Wang, Han Ting, Rakovich, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407478/
https://www.ncbi.nlm.nih.gov/pubmed/37559659
http://dx.doi.org/10.21037/jtd-22-1590
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author Larose, Jean-Christophe
Wang, Han Ting
Rakovich, George
author_facet Larose, Jean-Christophe
Wang, Han Ting
Rakovich, George
author_sort Larose, Jean-Christophe
collection PubMed
description BACKGROUND: Necrotizing pneumonia and lung gangrene represent a continuum of severe lung infection. Traditionally, severe cases have been referred for surgical debridement. However, this has been linked to high mortality. Some groups have published encouraging results using a conservative medical approach. Unfortunately, lack of a standardized definition of necrotizing pneumonia has precluded meaningful comparison between medical and surgical approach in severe cases. Our objective was to describe the outcome of a cohort of severe necrotizing pneumonia treated with optimal medical management. METHODS: We conducted an observational retrospective study by reviewing charts and radiology records of patients hospitalized between 2006–2019 in a tertiary center. We included all patients with severe necrotizing infection, defined as a necrotizing cavity involving at least 50% of a lobe, or smaller multilobar cavities. We made no distinction between necrotizing pneumonia and gangrene as there are no standardized criteria. RESULTS: A total of 50 consecutive patients were included. On imaging, 42% had multilobar cavities and mean diameter of the largest cavity in each case was 5.9 cm. 50% required mechanical ventilation (median duration 12 days) and 44% needed vasopressors. Four patients (8%) had decortication surgery, while none underwent lung resection. Four patients (8%) died. The extent of infiltrates and number of cavities were not associated with mortality but the extent of infiltrates was associated with risk of intubation (P=0.004). CONCLUSIONS: We presented one of the largest series of medically-treated severe necrotizing lung infections in the pre-coronavirus disease-2019 (COVID-19) era. The overwhelming majority of patients recovered with optimal medical management alone. Our results strongly support avoiding pulmonary resection in patients with severe necrotizing bacterial lung infections.
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spelling pubmed-104074782023-08-09 Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections Larose, Jean-Christophe Wang, Han Ting Rakovich, George J Thorac Dis Original Article BACKGROUND: Necrotizing pneumonia and lung gangrene represent a continuum of severe lung infection. Traditionally, severe cases have been referred for surgical debridement. However, this has been linked to high mortality. Some groups have published encouraging results using a conservative medical approach. Unfortunately, lack of a standardized definition of necrotizing pneumonia has precluded meaningful comparison between medical and surgical approach in severe cases. Our objective was to describe the outcome of a cohort of severe necrotizing pneumonia treated with optimal medical management. METHODS: We conducted an observational retrospective study by reviewing charts and radiology records of patients hospitalized between 2006–2019 in a tertiary center. We included all patients with severe necrotizing infection, defined as a necrotizing cavity involving at least 50% of a lobe, or smaller multilobar cavities. We made no distinction between necrotizing pneumonia and gangrene as there are no standardized criteria. RESULTS: A total of 50 consecutive patients were included. On imaging, 42% had multilobar cavities and mean diameter of the largest cavity in each case was 5.9 cm. 50% required mechanical ventilation (median duration 12 days) and 44% needed vasopressors. Four patients (8%) had decortication surgery, while none underwent lung resection. Four patients (8%) died. The extent of infiltrates and number of cavities were not associated with mortality but the extent of infiltrates was associated with risk of intubation (P=0.004). CONCLUSIONS: We presented one of the largest series of medically-treated severe necrotizing lung infections in the pre-coronavirus disease-2019 (COVID-19) era. The overwhelming majority of patients recovered with optimal medical management alone. Our results strongly support avoiding pulmonary resection in patients with severe necrotizing bacterial lung infections. AME Publishing Company 2023-07-20 2023-07-31 /pmc/articles/PMC10407478/ /pubmed/37559659 http://dx.doi.org/10.21037/jtd-22-1590 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Larose, Jean-Christophe
Wang, Han Ting
Rakovich, George
Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
title Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
title_full Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
title_fullStr Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
title_full_unstemmed Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
title_short Survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
title_sort survival with optimal medical management in a cohort of severe necrotizing bacterial lung infections
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407478/
https://www.ncbi.nlm.nih.gov/pubmed/37559659
http://dx.doi.org/10.21037/jtd-22-1590
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