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

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...

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Autores principales: Hsieh, Ming-Shun, Huang, Shih-Che, Loh, El-Wui, Tsai, Che-An, Hung, Ying-Ying, Tsan, Yu-Tse, Huang, Jin-An, Wang, Lee-Min, Hu, Sung-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878923/
https://www.ncbi.nlm.nih.gov/pubmed/24321123
http://dx.doi.org/10.1186/1471-2334-13-578
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author Hsieh, Ming-Shun
Huang, Shih-Che
Loh, El-Wui
Tsai, Che-An
Hung, Ying-Ying
Tsan, Yu-Tse
Huang, Jin-An
Wang, Lee-Min
Hu, Sung-Yuan
author_facet Hsieh, Ming-Shun
Huang, Shih-Che
Loh, El-Wui
Tsai, Che-An
Hung, Ying-Ying
Tsan, Yu-Tse
Huang, Jin-An
Wang, Lee-Min
Hu, Sung-Yuan
author_sort Hsieh, Ming-Shun
collection PubMed
description 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.
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spelling pubmed-38789232014-01-03 Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study Hsieh, Ming-Shun Huang, Shih-Che Loh, El-Wui Tsai, Che-An Hung, Ying-Ying Tsan, Yu-Tse Huang, Jin-An Wang, Lee-Min Hu, Sung-Yuan BMC Infect Dis Research Article 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. BioMed Central 2013-12-09 /pmc/articles/PMC3878923/ /pubmed/24321123 http://dx.doi.org/10.1186/1471-2334-13-578 Text en Copyright © 2013 Hsieh et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Hsieh, Ming-Shun
Huang, Shih-Che
Loh, El-Wui
Tsai, Che-An
Hung, Ying-Ying
Tsan, Yu-Tse
Huang, Jin-An
Wang, Lee-Min
Hu, Sung-Yuan
Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
title Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
title_full Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
title_fullStr Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
title_full_unstemmed Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
title_short Features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
title_sort features and treatment modality of iliopsoas abscess and its outcome: a 6-year hospital-based study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878923/
https://www.ncbi.nlm.nih.gov/pubmed/24321123
http://dx.doi.org/10.1186/1471-2334-13-578
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