Necrotizing pneumonia is a rare, but potentially deadly complication of bacterial pneumonia.
It is characterized by the finding of pneumonic consolidation with multiple areas of necrosis within the lung parenchyma. Necrotic foci may coalesce, resulting in a localized lung abscess, or pulmonary gangrene if involving an entire lobe.
Most common pathogens:S. aureus, S. pneumoniae, and Klebsiella pneumonia. Others include S. epidermidis, E. coli, Acinetobacter baumannii, H. influenzae and Pseudomonas.
Contrast-enhanced chest CT is the diagnostic test of choice and is also helpful in evaluating for parenchymal complications.
Empiric antibiotic therapy should include:
Broad spectrum coverage for commonly implicated pathogens (vancomycin, pseudomonal-dose piperacillin/tazobactam)
PLUS either clindamycin or metronidazole to cover possibly involved anaerobes
Consider an early surgical evaluation for the patient with necrotizing pneumonia complicated by septic shock, empyema, bronchopleural fistula, or hemoptysis.
References
Reference
Tsai YF, Ku YH. Necrotizing pneumonia: a rare complication of pneumonia requiring special consideration. Curr Opin Pulm Med. 2012 May; 18(3):246-52.
