The Treatment of Lung Abscess with Intratracheal Drug Instillation Method and the Significance of Intratracheal Bacteriology

Abstract

Since 1946, 116 patients suffering from Lung abscess were treated with intratracheal drug instillation method in this department of medicine. Of them, 104 cases have being been followed up for one to 21 years. The drugs used were chemotheraptique agents or antibiotics and, were instillated into intratracheal space by intercartilagenous puncture once every day or every other day for several months. The results obtained were considered as satisfactory; cured were 78 (76.0%), improved 16 (15.4%), unchanged 8 (7.7%), dead 1 (0.9%).
In 68 cases out of them, bacteriological examinations (mainly by aerobic culture) of intratracheal sputa withdrawn by intercartilagenous puncture were carried out by the author in parallel with the treatment.
The merits of this method as well as the clinical significance of intratracheal bacteriology were discussed in this paper
1) Advantages of the intercartilagenous puncture are that the sputa extracted can completely get rid of contamination from the upper respiratory tract, and its procedures are simple, easy, safe and not troublesome in repeating.
2) The patterns of intratracheal bacterial flora were nearly constant and stable according to each individual case in the course of treatment.
3) According to the kind of harbouring bacteria, the patients were divided into such four groups as: 1.-bacteria-free cases (25 cases) 2.-gram positive bacteria alone (17), of them, streptococcus (11) staphylococcus (6) 3.-ggram-negative bacteria alone (Bacillus coli group)(8) 4.-mixed group (18), combination of two or more kinds of bacteria such as Streptococcus, Staphylococcus, Bacillus coli group, Proteus, Pyocyaneus, Diphtheroid and Candida. In this, the combination of Streptococcus and B. coli group was predominant.
Considering these bacteriological patterns, the drugs to be applied were selected: chiefly, Penicillin to negative culture cases and cocci infection cases; Terramycin or Kanamycin to Bacilli infection; Peni cillin, Terramycin or Kanamycin, singly or alternately, to mixed infection cases.
4) Gram-negative Bacillus cases have shown the lowest cure rate (62.5%), compared to bacteriafree cases (92.0%), coccus infection (82.4%) and mixed infection (72.2%). As to the reason for this, such three factors were suggestive as: 1. Relatively later commencement of this therapy (later than a half year after onset of the illness in 50%). 2. Greater incidence in this cases of possessing the cavities and bronchectasis. 3 The inherent intractability of this bicillus. (More effective measures should be exploited in future to this group.)
5) As a whole, the bacteriologic-diagnostical and therapeutical value of this method is conspicuous, and the author considered it to be an indispensable clinical procedure in this disease.