Absceso del músculo iliopsoas: tratamiento y evolución en una serie de 35 pacientes

Abstract

The present study was aimed at reviewing the iliopsoas abscess (IPA) from a contemporary perspective, on the basis of experience from two tertiary referral centres. We performed a retrospective analysis of 35 cases of IPA diagnosed between 1998 and 2009. Their clinical and microbiological features were recorded, as well as their long-term outcome according to the type of treatment: antibiotics alone (10 patients), or antibiotics plus percutaneous drainage or surgery (25 patients). Primary abscess occurred in 8 patients. The most frequent source of secondary abscesses was spondylodiscitis. The classic clinical triad (fever, pain and functional impairment) was present in 10 patients, with a median duration of symptoms before diagnosis of 12 days. Staphylococcus aureus was the most frequently isolated microorganism. At the end of a median follow-up of 454 days, the risk of poor outcome (related death and/or relapse) was higher among patients with diabetes mellitus (44.4% vs. 7.7%; P=.027), with no significant differences according to the therapeutic approach (20.0% in the group of antibiotics alone vs. 28.0% in the group with drainage or surgery). In our series, most cases of IPA were due to S. aureus and secondary to a skeletal source. Antibiotic therapy seems effective in the long-term, although diabetic patients had a higher risk of relapse.