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Postgraduate Thesis: Retrospective review of clinical presentations, microbiology and outcome of psoas abscess in a regional hospital
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TitleRetrospective review of clinical presentations, microbiology and outcome of psoas abscess in a regional hospital
 
AuthorsWong, Oi-fung
黃凱峯
 
Issue Date2012
 
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
AbstractBackground: The clinical features of psoas abscess in local setting, including the microbial causes, the prevalence and etiologies of secondary psoas abscess, have not been well described. Objective: To review the clinical features and outcome of patients with psoas abscess in a regional hospital Method: A retrospective study was conducted. Patients with psoas abscess who were admitted into Tuen Mun Hospital from 1st January 2006 and 31st December 2010 were included. The clinical presentations, etiologies, microbiology, treatment, hospital stay, ICU admission and outcome were reviewed. Results: Forty-two cases were included. Five cases developed psoas abscess after admission. The average age was 60.9 ± 16.4 years (ranged 27 to 96 years). Twelve of them had diabetes mellitus and seven of them were intravenous drug abusers. The most common presenting symptoms were back, hip or thigh pain (43% [16/37]). Fever was present on presentation in 41% (15/37) of cases and four patients presented with fever only. Diagnosis was made by computerized tomography scan in 95.2% (40/42) of all the cases. Twenty-three cases were considered to be secondary and the most common etiology was infective spondylitis or spondylodiscitis. The most causative organism of primary psoas abscess was Staphylococcus aureus while secondary psoas abscesses were more commonly caused by organisms from gastrointestinal and genitourinary tracts. There was no statistical difference in the proportions of cases with bacteremia (p=0.404) between primary and secondary psoas abscess. Primary psoas abscess appeared to be associated with higher mortality but not to the extent of statistical significance (26.3% [5/19] Vs 4.3% [1/23]; p=0.075) while secondary psoas abscess had longer length of hospital stay (mean 62.1 days Vs 34 days; p=0.007). Half of the cases were treated with CT guided drainage and six cases were treated conservatively. Others were treated with ultrasound guided or surgical drainage. The overall in-hospital mortality rate was 14.3% (6/42). There was no significant difference in the mortality regardless of the causative organisms, the presence of bacteremia and background of diabetes mellitus. Elderly patients (more than 70) appeared to have higher mortality (66.7% [4/6]Vs 25% [9/36]; p=0.063). Mortality was not shown to be related to the delay in making diagnosis. Conclusion: Psoas abscess is an uncommon condition. Most patients presented with only nonspecific symptoms leading to the difficulty in making an early diagnosis. A larger proportion of secondary psoas abscess was encountered and the etiology profile was different from oversea experiences.
 
DescriptionThesis (P. Dip.)--University of Hong Kong, 2012.
"This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)."
Includes bibliographical references (p. 22-25).
 
DegreePostgraduate Diploma in Infectious Diseases
 
SubjectBack -- Abscess.
 
Dept/ProgramMicrobiology
 
DC FieldValue
dc.contributor.authorWong, Oi-fung
 
dc.contributor.author黃凱峯
 
dc.date.accessioned2012-11-01T02:50:31Z
 
dc.date.available2012-11-01T02:50:31Z
 
dc.date.issued2012
 
dc.description.abstractBackground: The clinical features of psoas abscess in local setting, including the microbial causes, the prevalence and etiologies of secondary psoas abscess, have not been well described. Objective: To review the clinical features and outcome of patients with psoas abscess in a regional hospital Method: A retrospective study was conducted. Patients with psoas abscess who were admitted into Tuen Mun Hospital from 1st January 2006 and 31st December 2010 were included. The clinical presentations, etiologies, microbiology, treatment, hospital stay, ICU admission and outcome were reviewed. Results: Forty-two cases were included. Five cases developed psoas abscess after admission. The average age was 60.9 ± 16.4 years (ranged 27 to 96 years). Twelve of them had diabetes mellitus and seven of them were intravenous drug abusers. The most common presenting symptoms were back, hip or thigh pain (43% [16/37]). Fever was present on presentation in 41% (15/37) of cases and four patients presented with fever only. Diagnosis was made by computerized tomography scan in 95.2% (40/42) of all the cases. Twenty-three cases were considered to be secondary and the most common etiology was infective spondylitis or spondylodiscitis. The most causative organism of primary psoas abscess was Staphylococcus aureus while secondary psoas abscesses were more commonly caused by organisms from gastrointestinal and genitourinary tracts. There was no statistical difference in the proportions of cases with bacteremia (p=0.404) between primary and secondary psoas abscess. Primary psoas abscess appeared to be associated with higher mortality but not to the extent of statistical significance (26.3% [5/19] Vs 4.3% [1/23]; p=0.075) while secondary psoas abscess had longer length of hospital stay (mean 62.1 days Vs 34 days; p=0.007). Half of the cases were treated with CT guided drainage and six cases were treated conservatively. Others were treated with ultrasound guided or surgical drainage. The overall in-hospital mortality rate was 14.3% (6/42). There was no significant difference in the mortality regardless of the causative organisms, the presence of bacteremia and background of diabetes mellitus. Elderly patients (more than 70) appeared to have higher mortality (66.7% [4/6]Vs 25% [9/36]; p=0.063). Mortality was not shown to be related to the delay in making diagnosis. Conclusion: Psoas abscess is an uncommon condition. Most patients presented with only nonspecific symptoms leading to the difficulty in making an early diagnosis. A larger proportion of secondary psoas abscess was encountered and the etiology profile was different from oversea experiences.
 
dc.description.naturepublished_or_final_version
 
dc.descriptionThesis (P. Dip.)--University of Hong Kong, 2012.
 
dc.description"This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)."
 
dc.descriptionIncludes bibliographical references (p. 22-25).
 
dc.description.thesisdisciplineMicrobiology
 
dc.description.thesislevelPostgraduate diploma
 
dc.description.thesisnamePostgraduate Diploma in Infectious Diseases
 
dc.identifier.hkulb4832028
 
dc.identifier.urihttp://hdl.handle.net/10722/173734
 
dc.languageeng
 
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.
 
dc.subject.lcshBack -- Abscess.
 
dc.titleRetrospective review of clinical presentations, microbiology and outcome of psoas abscess in a regional hospital
 
dc.typePG_Thesis
 
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<item><contributor.author>Wong, Oi-fung</contributor.author>
<contributor.author>&#40643;&#20977;&#23791;</contributor.author>
<date.accessioned>2012-11-01T02:50:31Z</date.accessioned>
<date.available>2012-11-01T02:50:31Z</date.available>
<date.issued>2012</date.issued>
<identifier.uri>http://hdl.handle.net/10722/173734</identifier.uri>
<description>Thesis (P. Dip.)--University of Hong Kong, 2012.</description>
<description>&quot;This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK).&quot;</description>
<description>Includes bibliographical references (p. 22-25).</description>
<description.abstract>Background: The clinical features of psoas abscess in local setting, including the
microbial causes, the prevalence and etiologies of secondary psoas abscess, have not
been well described.
Objective: To review the clinical features and outcome of patients with psoas
abscess in a regional hospital
Method: A retrospective study was conducted. Patients with psoas abscess who
were admitted into Tuen Mun Hospital from 1st January 2006 and 31st December
2010 were included. The clinical presentations, etiologies, microbiology, treatment,
hospital stay, ICU admission and outcome were reviewed.
Results: Forty-two cases were included. Five cases developed psoas abscess after
admission. The average age was 60.9 &#177; 16.4 years (ranged 27 to 96 years). Twelve
of them had diabetes mellitus and seven of them were intravenous drug abusers. The
most common presenting symptoms were back, hip or thigh pain (43% [16/37]).
Fever was present on presentation in 41% (15/37) of cases and four patients
presented with fever only. Diagnosis was made by computerized tomography scan in
95.2% (40/42) of all the cases. Twenty-three cases were considered to be secondary
and the most common etiology was infective spondylitis or spondylodiscitis. The
most causative organism of primary psoas abscess was Staphylococcus aureus while
secondary psoas abscesses were more commonly caused by organisms from
gastrointestinal and genitourinary tracts. There was no statistical difference in the
proportions of cases with bacteremia (p=0.404) between primary and secondary
psoas abscess. Primary psoas abscess appeared to be associated with higher
mortality but not to the extent of statistical significance (26.3% [5/19] Vs 4.3%
[1/23]; p=0.075) while secondary psoas abscess had longer length of hospital stay
(mean 62.1 days Vs 34 days; p=0.007). Half of the cases were treated with CT
guided drainage and six cases were treated conservatively. Others were treated with
ultrasound guided or surgical drainage. The overall in-hospital mortality rate was
14.3% (6/42). There was no significant difference in the mortality regardless of the
causative organisms, the presence of bacteremia and background of diabetes mellitus.
Elderly patients (more than 70) appeared to have higher mortality (66.7% [4/6]Vs
25% [9/36]; p=0.063). Mortality was not shown to be related to the delay in making
diagnosis.
Conclusion: Psoas abscess is an uncommon condition. Most patients presented with
only nonspecific symptoms leading to the difficulty in making an early diagnosis. A
larger proportion of secondary psoas abscess was encountered and the etiology
profile was different from oversea experiences.</description.abstract>
<language>eng</language>
<publisher>The University of Hong Kong (Pokfulam, Hong Kong)</publisher>
<rights>Creative Commons: Attribution 3.0 Hong Kong License</rights>
<rights>The author retains all proprietary rights, (such as patent rights) and the right to use in future works.</rights>
<subject.lcsh>Back -- Abscess.</subject.lcsh>
<title>Retrospective review of clinical presentations, microbiology and outcome of psoas abscess in a regional hospital</title>
<type>PG_Thesis</type>
<identifier.hkul>b4832028</identifier.hkul>
<description.thesisname>Postgraduate Diploma in Infectious Diseases</description.thesisname>
<description.thesislevel>Postgraduate diploma</description.thesislevel>
<description.thesisdiscipline>Microbiology</description.thesisdiscipline>
<description.nature>published_or_final_version</description.nature>
<bitstream.url>http://hub.hku.hk/bitstream/10722/173734/1/FullText.pdf</bitstream.url>
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