Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study

BMC Infectious Diseases

Sung-Yuan Hu⁶  Lee-Min Wang¹  Jin-An Huang⁵  Yu-Tse Tsan³  Ying-Ying Hung⁴  Che-An Tsai⁷  El-Wui Loh²  Shih-Che Huang⁸  Ming-Shun Hsieh⁶ 

[1] National Defense Medical Center, Taipei, Taiwan;Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan;School of Medicine, Chung Shan Medical University, Taichung, Taiwan;Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan;Department of Health Service Administration, China Medical University, Taichung, Taiwan;Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan;Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

关键词: Surgery;    Pyomyositis;    Psoas abscess;    Percutaneous drainage;    Iliopsoas abscess;   

Others  :  1145319
DOI  :  10.1186/1471-2334-13-578

 received in 2013-07-06, accepted in 2013-11-27,  发布年份 2013

【 摘 要 】

Background

Percutaneous drainage (PCD) and surgical intervention are two primary treatment options for iliopsoas abscess (IPA). However, there is currently no consensus on when to use PCD or surgical intervention, especially in patients with gas-forming IPA. This study compared the characteristics of patients with gas-forming and non-gas forming IPA and their mortality rates under different treatment modalities. An algorithm for selecting appropriate treatment for IPA patients is proposed based on our findings.

Methods

Eighty-eight IPA patients between July 2007 and February 2013 were enrolled in this retrospective study. Patients < 18 years of age or with an incomplete course of treatment were excluded. Demographic information, clinical characteristics, and outcomes of different treatment approaches were compared between gas-forming IPA and non-gas forming IPA patients.

Results

Among the 88 enrolled patients, 27 (31%) had gas-forming IPA and 61 (69%) had non-gas forming IPA. The overall intra-hospital mortality rate was 25%. The gas-forming IPA group had a higher intra-hospital mortality rate (12/27, 44.0%) than the non-gas forming IPA group (10/61, 16.4%) (P < 0.001). Only 2 of the 13 patients in the gas-forming IPA group initially accepting PCD had a good outcome (success rate = 15.4%). Three of the 11 IPA patients with failed initial PCD expired, and 8 of the 11 patients with failed initial PCD accepted salvage operation, of whom 5 survived. Seven of the 8 gas-forming IPA patients accepting primary surgical intervention survived (success rate = 87.5%). Only 1 of the 6 gas-forming IPA patients who accepted antibiotics alone, without PCD or surgical intervention, survived (success rate = 16.7%). In the non-gas forming IPA group, 23 of 61 patients initially accepted PCD, which was successful in 17 patients (73.9%). The success rate of PCD was much higher in the non-gas forming group than in the gas-forming group (P <0.01).

Conclusions

Based on the high failure rate of PCD and the high success rate of surgical intervention in our samples, we recommend early surgical intervention with appropriate antibiotic treatment for the patients with gas-forming IPA. Either PCD or primary surgical intervention is a suitable treatment for patients with non-gas forming IPA.

【 授权许可】

   
2013 Hsieh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Mallick IH, Thoufeeq MH, Rajendran TP: Iliopsoas abscesses. Postgrad Med J 2004, 80(946):459-462.
• [2]Ricci MA, Rose FB, Meyer KK: Pyogenic psoas abscess: worldwide variations in etiology. World J Surg 1986, 10(5):834-843.
• [3]Buttaro M, Gonzalez Della Valle A, Piccaluga F: Psoas abscess associated with infected total hip arthroplasty. J Arthroplasty 2002, 17(2):230-234.
• [4]Santaella RO, Fishman EK, Lipsett PA: Primary vs secondary iliopsoas abscess: presentation, microbiology, and treatment. Arch Surg 1995, 130(12):1309-1313.
• [5]Chern CH, Hu SC, Kao WF, Tsai J, Yen D, Lee CH: Psoas abscess: making an early diagnosis in the ED. Am J Emerg Med 1997, 15(1):83-88.
• [6]Kao PF, Tsui KH, Leu HS, Tsai MF, Tzen KY: Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning. Urology 2001, 57(2):246-251.
• [7]Tonolini M, Campari A, Bianco R: Common and unusual diseases involving the iliopsoas muscle compartment: spectrum of cross-sectional imaging findings. Abdom Imaging 2012, 37(1):118-139.
• [8]Cronin CG, Lohan DG, Meehan CP, Delappe E, McLoughlin R, O’Sullivan GJ, McCarthy P: Anatomy, pathology, imaging and intervention of the iliopsoas muscle revisited. Emergency radiology 2008, 15(5):295-310.
• [9]Lai YC, Lin PC, Wang WS, Lai JI: An update on Psoas muscle abscess: an 8-year experience and review of literature. Int J Gerontol 2011, 5(2):75.
• [10]Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T: Percutaneous drainage of psoas abscess under real-time computed tomography fluoroscopic guidance. Skeletal Radiol 2009, 38(3):275-280.
• [11]Yacoub WN, Sohn HJ, Chan S, Petrosyan M, Vermaire HM, Kelso RL, Towfigh S, Mason RJ: Psoas abscess rarely requires surgical intervention. Am J Surg 2008, 196(2):223-227.
• [12]Navarro Lopez V, Ramos JM, Meseguer V, Perez Arellano JL, Serrano R, Garcia Ordonez MA, Peralta G, Boix V, Pardo J, Conde A, et al.: Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore) 2009, 88(2):120-130.
• [13]Gruenwald I, Abrahamson J, Cohen O: Psoas abscess: case report and review of the literature. J Urol 1992, 147(6):1624-1626.
• [14]Chan JF, Hwang GY, Lamb S, Chan GS, So JC, Leung SS, To KK, Li IW, Cheng VC, Yuen KY: Pneumococcal native aortic valve endocarditis with mycotic abdominal aortic aneurysm, paraspinal and iliopsoas abscesses and pneumonia revealing a multiple myeloma. J Med Microbiol 2011, 60(Pt 6):851-855.
• [15]Hsu RB, Lin FY: Psoas abscess in patients with an infected aortic aneurysm. J Vasc Surg 2007, 46(2):230-235.
• [16]Chen SC, Tsai SJ, Chen CH, Huang CC, Lin DB, Wang PH, Chen CC, Lee MC: Predictors of mortality in patients with pyogenic liver abscess. Neth J Med 2008, 66(5):196-203.
• [17]Huang JJ, Tseng CC: Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000, 160(6):797-805.
• [18]Huang JJ, Chen KW, Ruaan MK: Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol 1991, 146(1):148-151.
• [19]Yang WH, Shen NC: Gas-forming infection of the urinary tract: an investigation of fermentation as a mechanism. J Urol 1990, 143(5):960-964.
• [20]Afaq A, Jain BK, Dargan P, Bhattacharya SK, Rauniyar RK, Kukreti R: Surgical drainage of primary iliopsoas abscess–safe and cost-effective treatment. Trop Doct 2002, 32(3):133-135.
• [21]Cantasdemir M, Kara B, Cebi D, Selcuk ND, Numan F: Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses. Clin Radiol 2003, 58(10):811-815.