{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:00:12Z","timestamp":1781071212567,"version":"3.54.1"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Lung abscesses can be difficult to treat despite long antibiotic courses, and treatment failure is frequently observed. Percutaneous drainage or surgical resection may be considered in select patients, and intracavitary antimicrobial instillation has been described for treatment failure in highly selected cases. We present a case of an immunosuppressed patient with acute respiratory distress syndrome who required mechanical ventilation and venovenous extracorporeal membrane oxygenation due to\n                    <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                    pneumonia with a large intrapulmonary abscess. The abscess was refractory to appropriate systemic antibiotic therapy, and direct intracavitary instillation was not feasible, so serial endobronchial antimicrobial lavage near the abscess site was used as salvage therapy to treat the abscess. Radiographic and clinical improvement were noted soon thereafter, without any observed adverse effects. Proximate endobronchial antimicrobial therapy was well tolerated and may be useful in additional cases of refractory pulmonary abscess. In this report, we describe the rationale and considerations underlying the choice of antimicrobial therapy.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1847731","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:20:45Z","timestamp":1781068845000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Endobronchial antibiotic instillation for refractory lung abscess due to Streptococcus pyogenes"],"prefix":"10.3389","volume":"13","author":[{"given":"Jennifer A.","family":"Doran","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli A.","family":"Keene","sequence":"additional","affiliation":[{"name":"Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis L.","family":"Pollema","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen F.","family":"Odish","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay R.","family":"Bharti","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea E.","family":"Roche","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth K.","family":"Weihe","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keriann M.","family":"Van Nostrand","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A.","family":"Mesarwi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego","place":["San Diego, CA, United States"]},{"name":"Section of Sleep Medicine, Jennifer Moreno Department of Veteran Affairs Medical Center","place":["San Diego, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4103\/1817-1737.91552","article-title":"An update on the drainage of pyogenic lung 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Radiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3431","DOI":"10.21037\/jtd-23-1561","article-title":"Lung abscess: the non-conservative management: a narrative review","volume":"16","author":"Hadid","year":"2024","journal-title":"J Thorac Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100991","DOI":"10.1016\/j.rmcr.2019.100991","article-title":"Antibiotic instillation for a chronic lung abscess","volume":"29","author":"Ainge-Allen","year":"2020","journal-title":"Respir Med Case Rep"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17030997","article-title":"Endoscopic treatment and pulmonary rehabilitation for Management of Lung Abscess in elderly lymphoma patients","volume":"17","author":"Cascone","year":"2020","journal-title":"Int J Environ Res Public Health"}],"container-title":["Frontiers in 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