Etiology and outcome of iliopsoas muscle abscess in Korea; changes  over a decade.
OBJECTIVE
Iliopsoas muscle abscess (IPA) is considered a rare disease whose etiology has changed depending on the country and antibiotic selection pressure. This study evaluates the changes in etiology, clinical outcome, and risk factors for mortality for IPA.


METHODS
We reviewed the medical records of a total of 116 patients with IPA who were admitted to 4 university hospitals in Korea over the 11 years, and compared the etiology between 2001 and 2006 (period 1, n = 44) and 2007–2012 (period 2, n = 72).


RESULTS
Among 75 cases with a definitive microbial diagnosis, the predominant etiological organisms were Staphylococcus aureus (45.3%), followed by Mycobacterium tuberculosis (14.7%) and Klebsiella pneumoniae (9.3%). The percentage of MRSA in period 2 increased remarkably compared to period 1, from 25% to 44.4%, and incidence of M. tuberculosis from 7.1% to 19.1%, although these were not statistically significant. The overall mortality was 6.8% in period 1, and 13.9% in period 2, and sepsis as an initial manifestation (OR 293.5, CI 7.1–12,034.4, P = 0.003) and serum creatinine level (OR 0.43, CI 0.23–0.80, P = 0.008) were independent predictors of mortality. Invasive procedure improved the prognosis in cases with microbiologic confirmed pyogenic psoas abscess (46/50 [92%] vs. 9/14 [64.3%], P = 0.008).


CONCLUSIONS
The incidence of MRSA as a cause of IPA is on the increase. Although the overall prevalence of tuberculosis is decreasing, tuberculosis is still an important cause of IPA. Initial clinical status and invasive intervention can lead to favorable outcomes.
Youn Jeong
YJ
Kim
Jai Hoon
JH
Yoon
Sang Il
SI
Kim
Seong Heon
SH
Wie
Yang Ree
YR
Kim
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016659:Psoas Abscess / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome