Therapie der ambulant erworbenen aspirationsassoziierten Lungenabszesse

Zusammenfassung:

Die Therapie von ambulant erworbenen aspirationsassoziierten Lungenabszessen ruht auf zwei Säulen: 1) der adäquaten antimikrobiellen Therapie und 2) der effektiven Drainage. Die kalkulierte antimikrobielle Therapie sollte aufgrund des Erregerspektrums aus einem Aminopenicillin/β-Laktamasehemmer oder Clindamycin bestehen. Das auf gram-positive Erreger eingeschränkte Spektrum des Clindamycins kann ggf. durch ein Cephalosporin der 2. Generation erweitert werden. Grundsätzlich sollte die antimikrobielle Therapie bis zur vollständigen Rückbildung der Abszesshöhle sowie der begleitenden Infiltrate fortgesetzt werden. Die Drainage besteht häufig spontan. Indikationen für den Einsatz zusätzlicher Drainagetechniken (bronchoskopische oder perkutane Drainage) können in seltenen Fällen bei klinischem Nichtansprechen und fehlender Rückbildung der Abszesshöhle bestehen. Chirurgische Notfallinterventionen betreffen im Wesentlichen schwere Blutungen. Zusammen mit einer adäquaten Drainage ist durch eine antimikrobielle Therapie eine Erfolgsrate von 75 - 90 % zu erwarten.

Treatment of Community-Acquired Lung Abscess Associated with Aspiration:

The management of community-acquired lung abscess associated with aspiration is based on adequate antimicrobial treatment and effective drainage. Empiric antimicrobial treatment should cover basic microbial patterns and consist of aminopenicillin/β-lactamase-inhibitor or clindamycin. Since the spectrum of clindamycin is restricted to Gram-positive microorganisms combination treatment of clindamycin with a second-generation cephalosporin may be warranted. It is crucial to continue antimicrobial treatment until complete resolution of the abscess cavity and the corresponding infiltrates. Drainage is frequently present spontaneously. Additional techniques to ensure effective drainage include bronchoscopic and percutaneous drainage. These techniques are only infrequently indicated in case of clinical failure and of delayed cavity closure. Indications for surgical emergency interventions are mainly limited to severe pulmonary hemorrhage. The clinical success rate of adequate antimicrobial treatment together with effective drainage reaches 75 - 90 %.

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