Emerging treatments
Bronchoscopy
Bronchoscopic lung abscess drainage is an emerging and feasible alternative to percutaneous catheter drainage or surgical resection, but its use remains uncommon in practice.[58][59] Specifically, the approach has potential advantages in select patient groups: abscess located centrally or near to a proximal airway; unchanged or increasing air-fluid level; unresolving sepsis after 3 to 4 days of antimicrobial therapy; suspected endobronchial tumour.[59] Note that bronchoscopy is not advisable for draining large abscesses (>6 cm diameter) because the sudden unloading of pus is associated with considerable risk of causing asphyxiation or acute respiratory distress syndrome.[60] Rigid bronchoscopy provides a greater capacity for suctioning, but is not popular, and endobronchial catheterisation with a laser has been used to drain refractory lung abscesses.[61] Existing evidence for bronchoscopic lung abscess drainage is based on case reports or case series in consultant centres.
Moxifloxacin
This antibiotic seems to treat aspiration pneumonia and primary lung abscess effectively. One study has found its efficacy and safety comparable to those of ampicillin/sulbactam, with a clinical response rate of 66.7% after a median duration of therapy of 30.5 days.[62][63]
Predictors of outcome in surgery for lung abscess
Identifying the predictors of outcome could help to clarify the role of surgery for lung abscess. One study of 91 patients found that significant predictors for fatal outcome were pulmonary sepsis, septic complications (air leak, pleural empyema), septic organ failure (respiratory, acute renal failure), and pre-existing comorbidity (Charlson index of comorbidity ≥3). The extent of surgical resection did not show a significant influence. The study also found that delayed referral for surgery is common.[64]
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