Role of surgery in the management of necrotizing pneumonia

Usually bacterial pneumonias run a benign course but can uncommonly present in a complicated form as necrotizing pneumonia (NP) which is characterized by liquefaction and cavitation of pulmonary tissue. The literature about surgical management of such cases is limited. We describe here our experience with parenchymal lung resections for NPs. Six patients underwent varying degree of lung resections for NP over a period of 2 years at a tertiary care hospital after failure of aggressive medical management. The records of these patients were analysed retrospectively. A comprehensive review of available literature was also performed. The surgical procedures included decortications, sublobar resections, lobectomy and bilobectomy. The pathogens isolated in pleural fluid and lung tissue were Streptococcus pneumoniae, Staphylococcus aureus, Acinetobacter baumanii, Burkholderia and Mycobacterium. Two patients out of six died in this series. Parenchymal lung resection may be a reasonable option in patients of NPs who have failed medical therapy, have persistent sepsis and whose computed tomography (CT) shows poor pulmonary vascular supply. However further studies are needed to firmly ascertain the role of surgery in such cases.