{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:56:49Z","timestamp":1781711809136,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Refractory thoracic infections require targeted antimicrobial combinations, repeated drainage interventions and often staged surgical procedures of varying complexity grades. In necrotizing pneumonia cases, successful treatment is complete removal of destroyed non-functional parenchyma, pleural cavity debridement, and complete pathogen eradication based on culture-based sensitivity-driven antimicrobials. The latter proves challenging in pan-resistant microbial strains where both medical and surgical treatments demonstrate limited effectiveness. We describe a case of persistent thoracic sepsis due to pan-resistant Pseudomonas receiving sequentially thoracoscopic decortication, thoracotomy for lobectomy, and open thoracostomy as the last treatment option to prevent fatal sepsis in view of non-available antibiotics. The immediate source-control effect raised the question of the ideal timing for selecting an aggressive thoracoplastic procedure despite its deforming nature over any other treatment approach.<\/jats:p>","DOI":"10.3390\/jcm15124711","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:11:22Z","timestamp":1781709082000},"page":"4711","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stepwise Surgical Management of Persistent Pleural and Parenchymal Sepsis Due to Pan-Resistant Pseudomonas Infection"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7460-5617","authenticated-orcid":false,"given":"Konstantinos","family":"Kostopanagiotou","sequence":"first","affiliation":[{"name":"Thoracic Surgery Department, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Karantana","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0817-1018","authenticated-orcid":false,"given":"Ma\u0142gorzata Edyta","family":"Wojty\u015b","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, Alfreda Soko\u0142owskiego 11, 70-891 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Santaintidis","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3102-1555","authenticated-orcid":false,"given":"Nikolaos","family":"Korodimos","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9502-7916","authenticated-orcid":false,"given":"Nektarios I.","family":"Koufopoulos","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2455-6966","authenticated-orcid":false,"given":"Theofanis","family":"Nastos","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3286-3779","authenticated-orcid":false,"given":"Arkadiusz","family":"Waloryszak","sequence":"additional","affiliation":[{"name":"Student Scientific Club of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7489-7776","authenticated-orcid":false,"given":"Konstantinos","family":"Thomas","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Tomos","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1159\/000117172","article-title":"Parapneumonic pleural effusion and empyema","volume":"75","author":"Koegelenberg","year":"2008","journal-title":"Respiration"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1177\/02184923211002408","article-title":"Thoracoplasty: Still relevant to current practice","volume":"29","author":"Phillip","year":"2021","journal-title":"Asian Cardiovasc. 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