Chapter 121. Intraabdominal Infections and Abscesses (Part 9)

Candida spp. can cause renal abscesses. This fungus may spread to the kidney hematogenously or by ascension from the bladder. The hallmark of the latter route of infection is ureteral obstruction with large fungal balls.The presentation of perinephric and renal abscesses is quite nonspecific. Flank pain and abdominal pain are common. At least 50% of patients are febrile. Pain may be referred to the groin or leg, particularly with extension of infection. The diagnosis of perinephric abscess, like that of splenic abscess, is frequently delayed, and the mortality rate in some series is appreciable, although lower than in the...
Nội dung trích xuất từ tài liệu:
Chapter 121. Intraabdominal Infections and Abscesses (Part 9) Chapter 121. Intraabdominal Infections and Abscesses (Part 9) Candida spp. can cause renal abscesses. This fungus may spread to thekidney hematogenously or by ascension from the bladder. The hallmark of thelatter route of infection is ureteral obstruction with large fungal balls. The presentation of perinephric and renal abscesses is quite nonspecific.Flank pain and abdominal pain are common. At least 50% of patients are febrile.Pain may be referred to the groin or leg, particularly with extension of infection.The diagnosis of perinephric abscess, like that of splenic abscess, is frequentlydelayed, and the mortality rate in some series is appreciable, although lower thanin the past. Perinephric or renal abscess should be most seriously considered whena patient presents with symptoms and signs of pyelonephritis and remains febrileafter 4 or 5 days of treatment. Moreover, when a urine culture yields apolymicrobial flora, when a patient is known to have renal stones, or when feverand pyuria coexist with a sterile urine culture, these diagnoses should beentertained. Renal ultrasonography and abdominal CT are the most useful diagnosticmodalities. If a renal or perinephric abscess is diagnosed, nephrolithiasis should beexcluded, especially when a high urinary pH suggests the presence of a urea-splitting organism. Perinephric and Renal Abscesses: Treatment Treatment for perinephric and renal abscesses, like that for otherintraabdominal abscesses, includes drainage of pus and antibiotic therapy directedat the organism(s) recovered. For perinephric abscesses, percutaneous drainage isusually successful. Psoas Abscesses The psoas muscle is another location in which abscesses are encountered.Psoas abscesses may arise from a hematogenous source, by contiguous spreadfrom an intraabdominal or pelvic process, or by contiguous spread from nearbybony structures (e.g., vertebral bodies). Associated osteomyelitis due to spreadfrom bone to muscle or from muscle to bone is common in psoas abscesses. WhenPotts disease was common, Mycobacterium tuberculosis was a frequent cause ofpsoas abscess. Currently, either S. aureus or a mixture of enteric organismsincluding aerobic and anaerobic gram-negative bacilli is usually isolated frompsoas abscesses in the United States. S. aureus is most likely to be isolated when apsoas abscess arises from hematogenous spread or a contiguous focus ofosteomyelitis; a mixed enteric flora is the most likely etiology when the abscesshas an intraabdominal or pelvic source. Patients with psoas abscesses frequentlypresent with fever, lower abdominal or back pain, or pain referred to the hip orknee. CT is the most useful diagnostic technique. Psoas Abscesses: Treatment Treatment includes surgical drainage and the administration of an antibioticregimen directed at the inciting organism(s). Pancreatic Abscesses See Chap. 307. Acknowledgment The substantial contributions of Dori F. Zaleznik, MD, to this chapter inprevious editions are gratefully acknowledged Further Readings Campillo B et al: Epidemiology of severe hospital-acquired infections inpatients with liver cirrhosis: Effect of long-term administration of norfloxacin.Clin Infect Dis 26:1066, 1998 [PMID: 9597225] Gibson FC III et al: Cellular mechanism of intraabdominal abscessformation by Bacteroides fragilis. J Immunol 160:5000, 1998 [PMID: 9590249] Johanssen EC, Madoff LC: Infections of the liver and biliary system, inPrinciples and Practice of Infectious Diseases, 6th ed, GL Mandell et al (eds).Philadelphia, Elsevier Churchill Livingstone, 2005, pp 951–959 Levison ME, Bush LM: Peritonitis and intraperitoneal abscesses, inPrinciples and Practice of Infectious Diseases, 6th ed, GL Mandell et al (eds).Philadelphia, Elsevier Churchill Livingstone, 2005, pp 927-945 Pappas PG et al: Guidelines for treatment of candidiasis. Clin Infect Dis38:161, 2004 [PMID: 14699449] Piraino B et al: Peritoneal dialysis–related infections recommendations:2005 update. Perit Dial Int 25:107, 2005 [PMID: 15796137] Rahimian J et al: Pyogenic liver abscess: Recent trends in etiology andmortality. Clin Infect Dis 39:1654, 2004 [PMID: 15578367] Solomkin JS et al: Guidelines for the selection of anti-infective agents forcomplicated intra-abdominal infections. Clin Infect Dis 37:997, 2003 [PMID:14523762] Tzianabos AO, Kasper DL: Anaerobic infections: General concepts, inPrinciples and Practice of Infectious Diseases, 6th ed, GL Mandell et al (eds).Philadelphia, Elsevier Churchill Livingstone, 2005, pp 2810–2816 ...