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Microbiology

OPEN TABLE 3 (bacteriologic results in ten cases of lung abscess)
OPEN TABLE 4a , TABLE 4b and TABLE 4c (with lists of bacteria, reference)

– anaerobic or mixed infection 78% of cases.

– aerobic alone only 16% of the time.

– main culprits:
• Gram + anaerobic cocci
• pigmented Gram Ð bacilli
• Fusobacteria

– in nosocomial infection, must consider Staph. aureus, and enteric Gram – bacilli.

– often do not need invasive diagnostic techniques. Can treat empirically.

– immunocompromised patients, do not forget:
• Aspergillus, Legionella, Cryptococcus, Pseudomonas, Nocardia
• AIDS population usually get cavitary upper lobe lesions, and lack typical aspiration risk factors

– immunocompetent patients, must consider:
• endemic fungi (Histoplasmosis, Coccidioides, Blastomyces)
• parasitic (Entamoeba, Echinococcus)
• TB

– Streptococcus pneumoniae rarely causes lung abscesses. If it does, it is usually in the context of obstruction, or of a mixed infection or superinfection. However, the type 3 strain can cause lung abscess as an isolated infection, because of its thick mucoid capsule.

– antiobiotic resistance increasing (esp. Bacteroides resistance to penicillin)

Open TABLE 5 (antibiotic resistance)

– have seen treatment failures to penicillin that have responded to clindamycin.


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