Recurrence Rate Of Abscess Research Articles

Prospective Randomized Trial of Simple Drainage vs. Drainage and Initial Fistula Management for Perianal Abscesses

Background and Aims: Perianal abscess is one of the most frequent proctological disorders and needs urgent treatment. Incision and drainage consists the gold standard therapy of this disorder. However, due to high rates of abscess recurrence, few surgeons favor primary fistula treatment at the time of abscess drainage to decrease the risk of recurrence. This clinical study was designed to compare incision and drainage of perianal abscess with or without fistula treatment. Patients and Methods: Two hundred consecutive patients suffering from acute perianal abscess were prospectively randomized into two groups: group A; treatment of abscess with incision and drainage, group B; incision and drainage plus primary fistula treatment. All patients were followed-up for at least 12 months. Primary endpoints of the study were the rates of abscess recurrence and anal incontinence. Secondary end point was abscess recurrence rate during the overall follow-up period.

Rural hospital outcomes versus non-rural hospital outcomes following emergency laparotomy: A Scottish retrospective cohort study

Rural hospital outcomes versus non-rural hospital outcomes following emergency laparotomy: A Scottish retrospective cohort study

PTU-210 Packing of perianal abscess cavities (PPAC) study: a multi-centre observational feasibility study, interim analysis: Abstract PTU-210 Table 1

<h3>Introduction</h3> Acute perianal abscess is the seventh most common emergency general surgery condition (18,000 cases/year).¹This study investigates the current management and health outcomes with the aim of demonstrating feasibility for a randomised controlled trial of packing versus no packing. <h3>Method</h3> Demographic and operative data was collected for all patients. Patients were asked to complete pain score diaries and QoL assessments using VAS and EQL-5D respectively, in addition to 1, 2, 3, 4, 8 week and 6 month follow up. This interim analysis was undertaken 11 months from study inception. <h3>Results</h3> 142 patients were recruited over 10 months at 15 centres. Mean age 39 years, 64% female. At operation, 9% had a fistula identified (no fistulotomies) and 97% were packed. Average number of dressing changes in 21 days was 7.4. Packing causes a double to three-fold increase in pain. Pain intensity halves after a week (Table 1). At 4 weeks, 48% healed. 8 week fistula rate was 21% and recurrence rate 9% (n = 2) at 6 months. 26 patients withdrew consent or were lost to follow-up. The estimated dressing and community nursing costs are £159.84 per patient, equating to £2,877,120 in England alone (18,000 patients per annum). <h3>Conclusion</h3> Packing is painful. A trial of packing versus no packing, based on pain scores, is feasible. If no packing is shown to be beneficial in terms of reduced pain and safe (no increased fistula or abscess recurrence rates), there could be considerable cost savings to the NHS and to patients, including reduced absence from work. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Hospital Epsiode Statistics. www.hscic.gov.uk/hes

Needle Aspiration versus Incision and Drainage for the Treatment of Peritonsillar Abscesses

Objectives: Peritonsillar abscesses are a common otolaryngological emergency. Needle aspiration and incision and drainage are the two main treatment modalities currently used. The effectiveness of one versus the other remains an area of debate among otolaryngologists. The objective of this review is to recognize whether needle aspiration or incision and drainage is the superior treatment for peritonsillar abscesses. Methods: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library); PubMed; EMBASE; Web of Science; ClinicalTrials.gov; and Google Scholar for relevant English studies. Selection criteria were applied to limit the review to randomized controlled trials comparing needle aspiration to incision and drainage in humans over the age of 12 years. The primary outcome studied was abscess recurrence rate. Results: Five studies were identified which compared needle aspiration to incision and drainage. All were of poor quality with no paper having a Jadad score above 2. One study reported a higher recurrence rate with needle aspiration and four no obvious difference in recurrence rate between the two techniques. Meta-analysis was inappropriate. Conclusions: Currently, there is insufficient evidence to determine which if any of the two treatments is superior. A sufficiently powered, well-designed randomized controlled clinical trial is required to compare the effectiveness of needle aspiration with incision and drainage for the treatment of peritonsillar abscesses.

Comparison of laparoscopic and open surgery for pyogenic liver abscess with biliary pathology

To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess (PLA) with biliary pathology. From January 2004 to October 2010, 31 patients with PLA combined with biliary pathology meeting entry criteria received surgical management in our hospital. Of the 31 patients, 13 underwent laparoscopic surgery (LS group) and 18 underwent open surgery (OS group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, length of postoperative hospital stay, and abscess recurrence rate were retrospectively analyzed and compared between the two groups. All patients received systemic antibiotic therapy. Four patients underwent ultrasound-guided percutaneous catheter drainage before operation. Postoperative complications occurred in 5 patients (16.1%, 5/31) including 2 in the LS group and 3 in the OS group. One patient had retained calculus in the common bile duct and another had liver abscess recurrence in the OS group. No retained calculus and liver abscess recurrence occurred in the LS group. In the two groups, there was no mortality during the perioperative period. There were no significant differences in operation time, intraoperative blood loss and transfusion, postoperative complication rate and abscess recurrence rate between the two groups. Oral intake was earlier (1.9 ± 0.4 d vs 3.1 ± 0.7 d, P < 0.05) and length of postoperative hospital stay was shorter (11.3 ± 2.9 d vs 14.5 ± 3.7 d, P < 0.05) in the LS group than in the OS group. Laparoscopic surgery for simultaneous treatment of PLA and biliary pathology is feasible in selected patients and the therapeutic effect is similar to that of open surgery.

Primary closure of cutaneous abscesses: a systematic review

Background Cutaneous abscesses have traditionally been treated with incision and drainage followed by secondary healing. Primary closure after incision and drainage is an alternative mode of therapy practiced in some parts of the world. The current study reviews the experience with primary closure of abscesses. Methods A systematic literature review was conducted using search terms abscess and primary closure. The databases searched included MEDLINE, PubMED, EMBASE, CINHAL, and the Cochrane Library between 1950 and 2009. The reference lists of the retrieved studies were also manually searched for additional studies. We performed a meta-analysis of all randomized clinical trials in which patients were randomized to either primary or secondary closure of incised and drained abscesses using Review Manager software. Results Of 33 articles retrieved, there were 7 randomized controlled trials in which 915 patients were randomized to primary (n = 455) or secondary (n = 460) closure. Many abscesses were located in the anogenital region and drained by surgeons. The time to healing after primary closure (7.8 days [95% confidence interval {CI}, 7.3-8.3]) was significantly shorter than that after secondary closure (15.0 days [95% CI, 14.3-15.7]; absolute difference, 7.3 days [95% CI, 6.9-7.6]). The rates of abscess recurrence after primary closure (7.6% [95% CI, 4.6-10.6]) were similar to those after secondary closure (11.1 days [95% CI, 7.5-14.7]; odds ratio, 0.66 [95% CI, 0.35-1.15]). Conclusions Studies from 4 countries suggest that primary closure of incised and drained abscesses results in faster healing and similar low abscess recurrence rates than after secondary closure. These studies provide a foundation for which clinical trials can be conducted in the United States.

MULTILOCULATED PYOGENIC BRAIN ABSCESS

To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses.We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess.The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess.Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.

Paediatric neck abscesses: microbiology and management

Paediatric neck abscesses remain common problems which are sometimes difficult to manage. We conducted a retrospective study of 64 children who underwent incision and drainage of neck abscesses at Leeds General Infirmary from 1 February 2002 to 31 July 2006. The aim of this study was to identify the presenting symptoms in children, the appropriateness of prescribed antibiotics and the role of atypical mycobacteria in neck infections. The outcome measure was clinical resolution of the abscess. The mean presenting age was 44.2 months (3.68 years). The commonest sign and symptom was neck mass (96.9 per cent). The mean period of hospitalisation was 3.7 (+/- standard deviation of 1.9) days. Staphylococcus aureus (48.4 per cent) was the commonest organism cultured. Atypical mycobacteria were found in only 4.7 per cent of the specimens. Flucloxacillin was the most common antibiotic used (57.8 per cent), often in combination with other antimicrobials. The abscess recurrence rate was 4.7 per cent. No fatalities occurred in this series of patients. Appropriately prescribed intravenous antibiotics and surgical drainage remain the central core of treatment. Atypical mycobacterial infection is an important differential diagnosis of a painless, cervico-facial mass. An algorithm for the management of paediatric neck abscesses is proposed.

Multiloculated Pyogenic Brain Abscess: Experience in 25 Patients

To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.