The Changing Pattern of Pulmonary Suppuration: Surgical Implications

¹ Division of Thoracic and Cardiovascular Surgery, Washington University School of Medicine

Of all the organ systems, the response of bacterial infection in the lung to antibiotic therapy has been the most dramatic. The entire clinical picture of pulmonary suppuration has changed forever. For this reason, the classic descriptions of disease must be discarded once and for all in favor of their drug-modified counterparts. Just as important, the continued emergence of drug-induced "mutant forms" must be constantly watched for and recognized. Out of the large pool of cases in whom antibiotics can affect total cure, we are confronted with a small but significant number of patients that have reacted to therapy in an unusual and sometimes even a bizarre way. The recognition and management of these cases often requires the best in judgment and experience on the part of the internist and the thoracic surgeon. Burford and Blades¹¹ recognized and voiced this problem early in the antibiotic era, when in 1942 they discussed the influence of sulfonamide therapy on postpneumonic empyema. Although this quotation is specific, its though is applicable to all types of pulmonary suppuration today: "There is no denying the vast prognostic difference" that sulfonamide has wrought in the pneumococcic and streptococcic pneumonias. Neither is there any doubt that treatment with these agents has brought about a decided reduction of the incidence of complications. However, it is our belief that the picture of postpneumonic empyema has become so atypical and bizarre since the universal use of sulfonamide therapy as to make re-evaluation of the disease necessary if we are to avoid committing grave errors in its treatment."