关于肺脓肿在危重病患者中的流行病学和管理数据稀缺。危重病患者肺脓肿的临床和微生物学特征是什么，如何在ICU中进行管理，ICU内死亡的危险因素是什么？本研究是一项回顾性观察性多中心研究，基于2015年至2022年法国ICD-10编码。通过多元逻辑回归确定与ICU内死亡相关的因素。我们分析了171例ICU患者的肺脓肿患者。其中78%为男性，平均年龄为56.5±16.4岁。20.4%过度饮酒，25.2%患有慢性肺病（14%为COPD），20.5%有癌症病史。总体而言，40.9%免疫功能低下，38%符合医院获得性感染标准。表现症状包括62%的疲劳或体重减轻，50.3%的发热和47.4%的呼吸困难。21.7%的患者报告有咳血情况。35.6%出现多菌感染。最常见的病原体是肠杆菌科（31%）、金黄色葡萄球菌（22%）和铜绿假单胞菌（19.3%）。10.5%为真菌感染。若特定临床影像学模式与特定微生物学检测相关，则可以指导经验性抗生素治疗方案。11.7%行经皮脓肿引流术，12.7%行手术治疗，12%因咳血需行支气管动脉栓塞术。ICU内死亡率为21.5%，年龄[OR：1.05（1.02-1.91），P=0.007]、ICU期间RRT [OR：3.56（1.24-10.57），P=0.019] 和真菌感染[OR：9.12（2.69-34.5），P=0.0006] 是多元逻辑回归后死亡的独立预测因子，而引流或手术并非预测死亡的因素。ICU中的肺脓肿是一种罕见但严重的疾病，通常由多菌感染引起，其中大部分是肠杆菌科、金黄色葡萄球菌和铜绿假单胞菌。超过三分之一的病例需要经皮引流、手术或动脉栓塞。需要进一步进行前瞻性研究，重点关注一线抗菌治疗和源控制措施，以改善和规范患者管理。版权所有 © 2023 Elsevier Inc. 发表。

Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses.What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICUs, and what are the risk factors of in-ICU mortality?Retrospective observational multicenter study, based on ICD-10 codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression.We analyzed 171 ICU patients with pulmonary abscesses. 78% were male with a mean age of 56.5 ± 16.4 years. 20.4% were excessive alcohol users, 25.2% had a chronic lung disease (14% COPD), and 20.5% had a history of cancer. Overall, 40.9% were immunocompromised and 38% qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%) and dyspnea (47.4%). Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, S. aureus in 22% and Pseudomonas aeruginosa in 19.3%. 10.5% were fungal infections. Several clusters of clinico-radiological patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. 11.7% had percutaneous abscess drainage; surgery was performed in 12.7%, and 12% required bronchial-artery embolization for hemoptysis. In-ICU mortality was 21.5%, and age [OR: 1.05 (1.02-1.91), P=0.007], RRT during ICU stay [OR: 3.56 (1.24-10.57), P=0.019], and fungal infection [OR: 9.12 (2.69-34.5), P=0.0006] were independent predictors of mortality after multivariate logistic regression, while drainage or surgery were not.Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection with a high proportion of Enterobacteriaceae, S. aureus, and P. aeruginosa. Percutaneous drainage, surgery or arterial embolization was required in more than a third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.Copyright © 2023. Published by Elsevier Inc.