piperacillin--tazobactam-drug-combination and Empyema--Pleural

Topics: Antifungal Agents; Aspergillus niger; Chest Pain; Diabetes Mellitus, Type 2; Empyema, Pleural; Female; Hemoglobin A; Humans; Middle Aged; Piperacillin, Tazobactam Drug Combination; Streptococcus agalactiae; Tomography, X-Ray Computed; Vancomycin; Voriconazole

We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. A follow-up chest CT performed to rule out bronchopleural fistula revealed a large lung abscess. The patient had the final diagnosis of a giant lung abscess, which was initially thought to be an empyema because of the clinical and radiologic similarities with this entity. The initial misdiagnosis led to prompt percutaneous drainage of the lung abscess in addition to antibiotherapy and respiratory physiotherapy with a good final outcome, which suggests the efficacy of this approach in similar cases.

Topics: Aged; Diagnostic Errors; Drainage; Empyema, Pleural; Humans; Lung Abscess; Male; Piperacillin, Tazobactam Drug Combination; Tomography, X-Ray Computed

Evidence from a recent randomized study of our group suggests that intravenous clarithromycin resulted in earlier resolution of ventilator-associated pneumonia. The need to understand the mechanism of action of clarithromycin guided to the study of a model of experimental empyema by multidrug-resistant Pseudomonas aeruginosa in 40 rabbits. Animals were randomized into controls (group A); treatment with clarithromycin (group B); treatment with piperacillin/tazobactam (group C); and treatment with both agents (group D). Pleural fluid was collected at regular time intervals for quantitative culture, estimation of cell apoptosis and of concentrations of tumour necrosis factor-alpha (TNFα). After 7 days, animals were euthanized for estimation of tissue growth. Bacterial growth in the pleural fluid of group D was significantly decreased compared with the other groups on day 5. Lung growth of group D was lower than group A. That was also the case of cytokine stimulation by pleural fluid samples on U937 monocytes. It is concluded that administration of clarithromycin enhanced the antimicrobial efficacy of piperacillin/tazobactam and decreased bacterial growth in the pleural fluid and in tissues. It also attenuated the pro-inflammatory phenomena induced by the β-lactam.

Topics: Adjuvants, Immunologic; Animals; Anti-Bacterial Agents; Apoptosis; Clarithromycin; Disease Models, Animal; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Empyema, Pleural; Humans; Interleukin-6; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pleural Effusion; Pseudomonas aeruginosa; Pseudomonas Infections; Rabbits; Tumor Necrosis Factor-alpha; U937 Cells

Topics: Abscess; Anti-Bacterial Agents; Debridement; Diabetes Mellitus, Type 2; Disease Susceptibility; Empyema, Pleural; Hematoma; Humans; Male; Middle Aged; Obesity, Morbid; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pleural Effusion; Smoking; Streptococcal Infections; Streptococcus agalactiae; Thoracic Injuries; Wound Infection; Wounds, Nonpenetrating

Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.

Topics: Anti-Bacterial Agents; Bacteroidaceae Infections; Chest Tubes; Drainage; Empyema, Pleural; Haemophilus Infections; Humans; Male; Mediastinitis; Mediastinum; Middle Aged; Necrosis; Penicillanic Acid; Peritonsillar Abscess; Piperacillin; Piperacillin, Tazobactam Drug Combination; Rupture, Spontaneous; Streptococcal Infections; Tomography, X-Ray Computed