Microbial etiology and management of lung abscesses in near-drowning survivors

Abstract Background Drowning is a leading global health issue, causing approximately 236,000 deaths annually, according to the World Health Organization. Non-fatal drowning, or near-drowning, occurs more frequently and is associated with severe pulmonary complications such as acute respiratory distress syndrome (ARDS), aspiration pneumonia, and lung abscess formation. The aspiration of water, pathogens, and particulate matter during submersion poses significant risks to lung health, often leading to infections that can progress into severe conditions like lung abscesses. Purpose This review aims to provide an in-depth analysis of the pathogenesis, diagnosis, treatment, and outcomes of lung abscess formation following near-drowning events. Emphasis is placed on understanding the transition from aspiration pneumonia to abscess development, with a focus on microbial etiology, diagnostic approaches, and therapeutic interventions. Main body Aspiration during near-drowning introduces anaerobic and aerobic pathogens into the lungs, including Bacteroides , Streptococcus pneumoniae , and Staphylococcus aureus , which can lead to lung abscess formation. Additionally, opportunistic fungi like Aspergillus and Candida species may contribute to infection, particularly in immunocompromised patients, complicating treatment and worsening outcomes. The pathogenesis involves necrosis and pus accumulation within a localized lung cavity. Diagnosis primarily relies on imaging techniques such as chest radiography and computed tomography (CT), which reveal air-fluid levels characteristic of abscesses. Microbiological tests, including sputum cultures, bronchoalveolar lavage, and fungal-specific assays, are essential for pathogen identification. Treatment includes prolonged antibiotic therapy targeting both anaerobes and aerobes, antifungal medications when indicated, and drainage procedures considered for larger or refractory abscesses. Conclusion With timely diagnosis and appropriate management, the prognosis for lung abscesses following near-drowning is generally favorable. However, delayed treatment or the presence of comorbidities can lead to complications such as empyema and chronic lung damage. Regular follow-up is crucial to monitor for long-term pulmonary sequelae, including bronchiectasis and recurrent infections. Graphical Abstract