Epidemiology of and risk factors for iliopsoas abscess in a large community-based study

Ouellette, Lindsey; Hamati, Mary C.; Flannigan, Matt; Singh, Maninderpal; Bush, C.; Jones, J. Stephen

doi:10.1016/j.ajem.2018.05.021

Cited by 18 publications

(23 citation statements)

References 4 publications

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“…Clinical management with PCD and appropriate antibiotic therapy was safe and effective with shorter hospital stay for IPA. Open surgical intervention might be warranted if there was an underlying pathology [9–11]. Risk factors associated with mortality in IPA caused by CVD were found in our present study to include hypoalbuminemia, hyponatremia, involving disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days.…”

Section: Discussionmentioning

confidence: 50%

“…These results were similar to those by Ouellette et al, on 109 patients of secondary IPA. They reported 15 cases (13.8%) of IPA caused by CVD, that included infected vascular graft (6, 40.0%), infected catheter (5, 33.3%), endocarditis (3, 20.0%), and infected fistula (1, 6.7%) [9]. We found the most common microorganism of blood culture beings Gram-positive cocci (9, 60%), like staphylococci (6, 40%) and streptococci (1, 6.7%).…”

Section: Discussionmentioning

confidence: 99%

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Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

Hsieh

Chang

et al. 2019

BMC Musculoskelet Disord

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BackgroundIliopsoas abscess (IPA) is a rare clinical entity and is difficult to diagnose due to its insidious onset and nonspecific symptoms. The association between IPA and cardiovascular disorders (CVD) has been rarely reported. Computed tomographic (CT) scan can provide a definitive diagnosis of IPA and associated foci of adjacent structures. IPA is a life-threatening condition, especially when associated with CVD.Materials and methodsWe conducted a hospital-based observational study of IPA associated with CVD. Data were collected from the electronic clinical database of Taichung Veterans General Hospital (1520-bed tertiary referral hospital in central Taiwan) between July 2007 and December 2017. The diagnosis of IPA associated with CVD was confirmed by classical findings on CT and transesophageal echocardiography with compatible clinical presentation and cultures from pus/tissue and blood.ResultsFifteen patients of IPA associated with CVD were studied. They included 12 males (80%) and 3 females (20%), with a mean age 63.2 ± 16.9 years (31–85 years). CVD included stent-graft/endograft infection of abdominal aortic aneurysm (AAA) (40%), primary mycotic AAA (33.3%), and infective endocarditis (26.7%). Staphylococcus aureus is the most common microorganism in pus/tissue cultures (n = 3, 37.5%) and in blood cultures (n = 6, 40%). The average length of hospital stay was 33.1 ± 20.5 days (range, 3–81 days; median, 33 days). Hospital stay lasted 42.6 ± 19.2 days in the survival group and 19.0 ± 14.1 days (P = 0.018) in the non-survival group. Incidence of patients staying in the intensive care unit (ICU) with intubation > 3 days was 33% in the survival group and 100% (P = 0.028) in the non-survival group. Intra-hospital mortality rate was 40%. Poor prognostic factors in the non-survival group were hypoalbuminemia, hyponatremia, involved disc/vertebral body and/or epidural abscess, and ICU stay with intubation > 3 days. Cumulative survival rate was 25% under conservative treatments and 66.3% under aggressive treatments (P = 0.038).ConclusionDue to high mortality rates, clinicians should keep a high suspicion index for IPA associated with CVD through clinical presentation, physical examination, and imaging study. Timely empiric antibiotics for common bacteria, drainage for IPA, endovascular repair, or vascular reconstruction by graft replacement or bypass with intensive care should be mandatory to shorten the hospital stay, reduce medical costs, and lower mortality rate.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

Hsieh

Chang

et al. 2019

BMC Musculoskelet Disord

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“…The formation of psoas abscess can be due to lymphatic or hematogenous spread of infection, usually in patients with chronic conditions such as Diabetes Mellitus, chronic kidney disease, drug abuse, or immunosuppression. However direct spread and formation of the abscess are possible in cases like Crohn's disease, appendicitis, pancreatitis, diverticulitis, urinary tract infections, osteomyelitis of vertebral bodies, or spondylodiscitis [3].…”

Section: Discussionmentioning

confidence: 99%

Psoas Abscess Presented as Right Hip Pain in a Young Adult With Crohn’s Disease

Doukas¹,

Bhandari²,

Dixon³

2021

Cureus

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A 27-year-old man with a past medical history of Crohn's disease presented in the Emergency Department complaining of right hip pain that has been going on for one month. At presentation, the patient was tachycardic. Physical examination revealed a positive psoas sign. Laboratory tests showed elevated white blood cells, C-reactive protein, and erythrocyte sedimentation rate. Computed tomography of the abdomen and pelvis revealed ileo-psoas fistula and psoas abscess. This rare case aims to provide awareness that intraabdominal pathology should always be suspected in patients with referred hip pain and Crohn's disease. A thorough physical examination including maneuvers for assessment of possible iliopsoas inflammation should be effectively performed at the bedside to determine the likelihood of the condition and proper imaging should follow to confirm the diagnosis.

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“…A psoas abscess is rare (the incidence is 0.4/100,000 [ 1 ] ) but may be devastating, placing patients at risk of neurological deficits, septic shock, and even death. [ 2 ] The common symptoms include fever, persistent back pain, and limitation of hip motion. [ 3 – 5 ] However, as the symptomatology varies and the clinical features are non-specific, diagnosis and effective management are frequently delayed.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic drainage as a minimally invasive treatment for a psoas abscess

Hong¹,

Hong²,

Bae

et al. 2020

Medicine

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A psoas abscess is a rare but potentially devastating condition that is associated with risks of neurological deficits, septic shock, and even death. The current first-line treatment is percutaneous catheter drainage (PCD) under imaging guidance, combined with broad-spectrum antibiotics. Surgical drainage should be considered if PCD fails or is impossible. Although many studies on PCD and open surgical drainage have appeared, the outcomes of laparoscopic drainage have rarely been reported. Thus, we laparoscopically drained the psoas abscesses of 6 patients; drainage was complete and we encountered no recurrence or complication. All patients were evaluated by plain radiography, contrast-enhanced computed tomography, and laboratory tests; all were followed-up for 1 year. Laparoscopic drainage is a good treatment option when PCD fails, affording all the advantages of open surgery (complete drainage, resection of infected tissue, and contermporaneous treatment of concomitant lesions). Also, laparoscopic drainage is minimally invasive, requires a smaller incision, and allows rapid recovery.

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Epidemiology of and risk factors for iliopsoas abscess in a large community-based study

Cited by 18 publications

References 4 publications

Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

Clinical features, management, and outcome of iliopsoas abscess associated with cardiovascular disorders: a hospital-based observational case series study

Psoas Abscess Presented as Right Hip Pain in a Young Adult With Crohn’s Disease

Laparoscopic drainage as a minimally invasive treatment for a psoas abscess

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