Lung abscess due to Staphylococcus aureus

Staphylococcus aureus lung abscess can be a complication of staphylococcal pneumonia or S. aureus bacteraemia. If S. aureus is confirmed or strongly suspected to be the cause of lung abscess, assess the likely source of infection:

• if the patient has a recent history of pneumonia, manage as for Staphylococcus aureus (staphylococcal) pneumonia while awaiting the results of blood culture
• in people who inject drugs or in people with an intravascular device in situ, manage initially as for Staphylococcus aureus bacteraemia.

If gram-positive cocci in clusters are identified by Gram stain of a blood sample, see Staphylococcus aureus bacteraemia, including sepsis and septic shock for management and duration of therapy. Typically, S. aureus bacteraemia complicated by a lung abscess is considered a metastatic infection and requires a longer duration of therapy than uncomplicated S. aureus bacteraemia.

The total duration of therapy (intravenous + oral) for lung abscess due to staphylococcal pneumonia is usually 3 to 4 weeks. For abscesses with persistent fluid, a longer duration of therapy may be required – seek expert adviceMcMullan 2016.