Comparative Study of Antibiotic Regimens for Lung Abscess Treatment

Abstract

Over the last 10-15 years, the problem of suppurative lung diseases has rarely been discussed in foreign literature, but remains relevant for our country. Lung abscess is a common clinical problem in developing countries, the mortality rate of lung abscess is 8.7%. The incidence of lung abscess in hospitalized patients is about 7-8 per 10000 per year. A lung abscess is an intrapulmonary cavity limited by a granulation ridge and a zone of perifocal infiltration, formed as a result of the decay of necrotic areas of lung tissue and containing pus. With widespread destruction of the lungs caused by the association of highly virulent, polyresistant microorganisms, the results of treatment remain unsatisfactory to this day and mortality remains high: with acute abscess it is 2.5-4%, limited gangrene (gangrenous abscess) - 8-10%, widespread - 45-50%. When any etiologic factor of suppurative lung diseases is realized, acute pneumonia with known clinical manifestations first develops. In most cases, as a result of timely rational therapy, the acute inflammatory process is reversible - the infection is suppressed, the alveolar exudate is resorbed, and the inflammatory infiltrate is resolved. Otherwise, under certain conditions and unfavorable circumstances, necrosis of the lung tissue develops with subsequent formation of destruction cavities.

In the etiopathogenesis of acute pulmonary suppurations, non-spore-forming anaerobic microorganisms play a leading role. More than 300 species of pathogens of this group are known, capable of causing destruction of the lungs. Of the purulent foci, Bacteroides, Fusobacterium, Peptostreptococcus, Peptococcus and others are most often isolated, that is, flora that usually colonizes the nasopharyngeal region. In acute abscess and gangrene of the lung, non-spore-forming anaerobes are always found in association with aerobic hospital strains. Most often these are Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, etc. In the pathogenesis of bacterial destruction of the lung, great importance is attached to the disruption of the patency of the bronchial branches with the formation of atelectasis, as well as the disruption of blood circulation in the bronchial and pulmonary vessels with the development of ischemia of the bronchopulmonary structures. It arises majorly from aspiration of oral bacteria, complications from other lung diseases or bacterial pneumonia. A lung abscess It is potentially a life threatening condition that requires appropriate treatment. Comparative study of the antibiotic regimens aim to determine appropriate and most effective treatment approach it majorly involves comparing different antibiotic combinations, dose adjustment and time duration to identify optimal treatment plan or therapy for specific population.

Treatment of acute bacterial destruction of the lung is the unconditional prerogative of surgeons. The best results are achieved in specialized thoracic departments. The severity of the patient's condition requires a variety of intensive care, parasurgical procedures and emergency surgeries when complications arise.

Conservative treatment includes infusion media and drugs capable of correcting homeostasis disorders that develop as a result of prolonged intoxication, hypoxemia and anorexia. Methods of efferent therapy and gravitational surgery are used, provided that the abscesses are adequately drained.

When a patient with acute bacterial destruction of the lungs is admitted to a surgical hospital, empirical antibacterial therapy is immediately prescribed based on data on the polymicrobial etiology of pleuropulmonary infection. Subsequently, the prescriptions are adjusted taking into account the results of microbiological examination of the contents of the abscesses. Combined antibacterial therapy is often used in the treatment of acute abscess of the lung. However, monotherapy with cefoperazone/sulbactam or carbapenems is possible. In the acute period of the disease, antibiotics are administered mainly intravenously. An indispensable condition for antibacterial therapy is the prevention of systemic mycosis with antifungal agents (diflucan, mycosyst, flucosanol, etc.).