Lung Abscess Caused by Pseudomonas aeruginosa after a Near-drowning Episode
Abstract
Aspiration pneumonia is one of the most severe complications associated with near-drowning and is referred to as drowning-associated pneumonia (DAP). Inhaled water may be contaminated by various pathogens, thereby facilitating DAP development. The causative organisms of DAP differ from those of community-acquired pneumonia, with Gram-negative bacilli being predominant. We herein report an 83-year-old Japanese man with chronic kidney disease who presented to the emergency department after a near-drowning episode. His oxygen saturation level was 86% despite receiving oxygen via a 10 L/min reservoir mask. He was admitted to the intensive-care unit, where high-flow nasal cannula therapy (50 L/min with an FiO2 of 1.0) was initiated. His respiratory condition gradually improved, and he was transferred to the general ward. However, on day 10 of hospitalization, the patient developed a fever. Chest computed tomography (CT) revealed a new cavity in the right upper lobe, which was suggestive of a lung abscess. Ceftriaxone was initiated but was ineffective. Sputum culture on day 10 revealed Pseudomonas aeruginosa, and cefepime was subsequently administered. His fever resolved, and follow-up CT on day 23 showed marked improvement in the cavity and surrounding consolidation. Due to suspected cefepime-induced acute kidney injury, the antibiotics were switched to moxifloxacin, and the patient was discharged on hospital day 28. Following macroaspiration events, clinicians should evaluate…
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