Selecting a Treatment Regimen
Table 3. Relative Indications for Surgical Treatment of IA*
Condition
Surgical Procedure
Pulmonary lesion in
proximity to great
vessels or pericardium
Pericardial infection
Resection of
pulmonary lesion
May prevent erosion of pulmonary lesions
into great vessels and into pericardial space
Pericardiectomy
Invasion of chest
wall from contiguous
pulmonary lesion
Aspergillus empyema
Resection of
pulmonary lesion
Pericardiectomy reduces organism burden
around heart and prevents tamponade
Resection of lesion may relieve pain and
prevent pleurocutaneous fistula
Persistent hemoptysis
from a single cavitary
lesion
Infection of skin and
soft tissues
Infected vascular
catheters and
prosthetic devices
Endocarditis
Osteomyelitis
Placement of chest
tube
Resection of cavity
Comment
Reduces burden of organism in closed space
May prevent exsanguinating hemoptysis;
other measures to reduce hemoptysis include
embolization of involved blood vessel
and cauterization; however, recurrence of
bleeding is possible
Surgical judgment used in extent of
debridement and resection, if indicated
Debridement; wide
margin surgical
resection
Removal of catheters Removal of infected catheters and devices
and devices
provides definitive eradication
Resection of
vegetation and
infected valve
Debridement of
infected bone
Sinusitis
Resection of
infected tissues
Cerebral lesions
Resection of
infected tissue
Vegetations may be valvular or mural; single
mural lesions are resectable, particularly if
pedunculated
Debridement of necrotic and infected bone
reduces organism burden and allows better
penetration; surgical judgment determines
extent of debridement
Extent of debridement may vary from no
intervention to wide resection, depending on
surgical judgment
Extent of debridement may vary from
no intervention to complete resection
depending on location, neurological sequelae,
accessibility, and surgical judgment
* Indications depend on multiple variables, severity of lesion, surgical judgment and the ability of patient
to tolerate the operative procedure, and potential role of alternative medical therapy.
