Pyogenic psoas abscess: worldwide variations in etiology.

Abstract

AbstractPyogenic abscess of the psoas muscle results from primary suppuration or direct extension of intraabdominal infection. The etiology varies with the country of origin. Our experience with 9 cases prompted a review of 367 cases from the world literature. A total of 286 primary abscesses occurred mainly in developing nations (200 cases), although 74 were reported from the United States. Younger patients predominated in developing nations (81.4% <20 years old), while only 47.8% from the United States were younger than 20 years. PureStaphylococcus aureus was commonly cultured (88.4%); simple incision and drainage cured 97.3% of patients with primary psoas abscess. Of 7 (2.5%) patients who died, 6 were from the United States; therapy was inadequate or delayed in all 7 patients. Ninety secondary abscesses appeared almost exclusively in reports from Europe, the United States, and Canada. Crohn's disease was the most common etiology followed by appendicitis and colon inflammation or cancer; mixed enteric infections predominated (55.7%). Although rare during the first decade, distribution was otherwise relatively even across all age groups. Simple drainage succeeded in only 49% of cases. Higher mortality accompanied secondary abscess (17 cases, 18.9%). The etiology of pyogenic psoas abscess guides the selection of proper medical and surgical therapy. While primary abscess is the likely etiology in developing nations and secondary abscess in Europe, either may occur in the United States. Early diagnosis and proper therapy are necessary to reduce mortality.