Transthoracic Drainage of Lung Abscesses. A National Randomized Trial.

This study aims to investigate if early drainage of lung abscesses, in addition to standard antibiotic treatment, leads to shorter length of hospital stay.

Study Design

This is a randomized, controlled clinical trial. That means participants will be randomly assigned to one of two groups:

1. Drainage group: Receives a chest tube (drain) inserted through the chest wall into the abscess in combination with standard intravenous antibiotics. 2. Control group: Receives standard intravenous antibiotics only

Each participant has a 50/50 chance of being placed in either group.

During Hospital Stay All participants will begin treatment with intravenous antibiotics (piperacillin/tazobactam). If assigned to the drainage group, a trained medical team will insert a small tube into the abscess to drain the pus. The tube is flushed three times a day with sterile saline.

Participants will also:

* Fill out two short health questionnaires at the start and during follow-up. * Have relevant medical history collected from their hospital records. * Undergo routine scans (CT), blood tests, and lung assessments as part of standard care. * A cheek swab will be taken from all participants to study mouth bacteria..

For those receiving drainage the pus from the lung abscess will be collected for microbiological analysis.

Microbiology samples will be stored in a research biobank and destroyed after analysis.

Follow-up after discharge

* 1 week: A phone call to check symptoms and infection levels via a blood test. * 4 and 12 weeks later: In-person checkups at the lung clinic, including:

* 6-minute walk test * Lung function test * Repeat health questionnaires * CT scan * Blood tests (up to 20 ml in total over the study) * 1 years: Medical records are reviewed to asses morbidity and mortality.

Participants The study will include 84 adult patients who are hospitalized with a lung abscess larger than 4 cm, located near the outer part of the lung. Inclusion will take place at five university hospitals in Denmark

Why This Study Matters There are no official guidelines for treating lung abscesses, and research is limited. This study could offer vital new insights that help update treatment recommendations in Denmark and internationally.

Because all five Danish regions are involved, the results could quickly be implemented into daily practice, improving care for future patients with this serious condition.