Subphrenic abscess: comparison between operative and antibiotic management.
Subphrenic abscess is still a significant hazard which complicates surgical procedures as well as certain abdominal catastrophes. This is a report of 88 patients with subphrenic abscess at St. Vincent's Hospital and Medical Center of New York from 1954 through 1971. There were 46 males and 42 females, ranging from 2 to 88 years. Operations on the stomach, duodenum and biliary tract were the major causes. The causative organisms in order of frequency were: E coli (41.6%), Staphylococcus (41.6%), Aerobacter aerogenes (23.3%), Proteus (20%), Streptococci (18.3%) and Pseudomonas (8.3%). Penicillin and tetracycline, the antibiotics most commonly chosen on an empiric basis, proved effective in only 38% of cases. On the other hand, kanamycin, chloramphenicol and cephalothin were effective in 90%, 85% and 70% of cases respectively. The overall mortality rate was 15%. Nine of the 21 patients (42.8%) treated with antibiotics alone died while 11 of 67 patients (10.6%) treated with antibiotics and surgical drainage died. Some of the latter deaths occurred in patients treated with prolonged antibiotic therapy and operated on only as a last resort. In this series subphrenic abscess was best treated by early surgical drainage combined with the use of appropriate antibiotics.
D000007:Abdominal Injuries / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007612:Kanamycin / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D013369:Subphrenic Abscess / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D013514:Surgical Procedures, Operative / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D007612:Kanamycin; D002701:Chloramphenicol; D003091:Colistin