Necrotizing pneumonia: a rare complication of pneumonia requiring special consideration

Curr Opin Pulm Med. 2012 May;18(3):246-52. doi: 10.1097/MCP.0b013e3283521022.


Purpose of review: Necrotizing pneumonia is a rare complication of bacterial lung infection. Its cause is owing to either a virulence factor of the microorganism or a predisposing factor of the host. This disease may cause devastating complications such as diffuse pulmonary inflammation, septic shock, and respiratory failure, making treatment more difficult. In the recent decade, the cause of necrotizing pneumonia and the role of surgical treatment have raised considerable attention, leading to therapeutically specific suggestions.

Recent findings: Staphylococcus aureus strains that produce Panton-Valentine leukocidin have been reported to cause rapidly progressive necrosis of the lung tissue in young immunocompetent patients. Furthermore, recent studies have showed the risk of disease progression is associated with underlying medical conditions. Although antibiotics are the first choice of treatment for necrotizing pneumonia, it has been emphasized that surgical treatment is a feasible alternative option in patients who fail to respond to antibiotics and develop continued deterioration and complications.

Summary: The current knowledge of cause, clinical features, diagnosis, treatment, and prognosis of necrotizing pneumonia are summarized. Antibiotics remain the mainstay of treatment. Lung resection can be considered an alternative treatment option in patients who are unresponsive to antibiotic therapy and develop parenchymal complications. Outcome is affected by the degree of disease progression and comorbidities.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Toxins
  • Exotoxins / metabolism
  • Humans
  • Klebsiella pneumoniae
  • Leukocidins / metabolism
  • Necrosis / diagnosis
  • Necrosis / microbiology*
  • Necrosis / therapy
  • Pneumonia, Bacterial / complications*
  • Pneumonia, Bacterial / drug therapy
  • Prognosis
  • Pulmonary Surgical Procedures / methods*
  • Staphylococcus aureus / metabolism
  • Streptococcus pneumoniae


  • Anti-Bacterial Agents
  • Bacterial Toxins
  • Exotoxins
  • Leukocidins
  • Panton-Valentine leukocidin