Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess.
OBJECTIVE
Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD).


METHODS
We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome.


RESULTS
The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome.


CONCLUSIONS
Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.
Cinat
Marianne E
ME
Department of Surgery, University of California, Irvine Medical Center, 101 City Dr, Bldg 53, Rte 81, Orange, CA 92868, USA. mecinat@uci.edu
Wilson
Samuel E
SE
Din
Adnan M
AM
D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D004322:Drainage / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013813:Therapy, Computer-Assisted / Q000379:methods / Q000592:standards*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography