Risk Factors For Abscess Formation Research Articles

Risk stratification of residual abscess after surgical treatment for gastroduodenal perforation

AbstractAimsResidual abscess is a major complication after emergency surgery for gastroduodenal (GD) perforation. However, there is little evidence regarding potential risk factors contributing to its development. Establishing a risk stratification strategy would be valuable for the entire management process.MethodsThis single‐center, retrospective study analyzed 115 consecutive patients who underwent surgery for GD perforation between 2010 and 2023 at a secondary emergency care hospital. Patients were divided into two groups based on the presence or absence of residual abscesses. Potential risk factors for abscess formation were evaluated from various aspects.ResultsThe incidence of residual abscesses was 19.1% (22 of 115). Multivariable analysis revealed that current use of nonsteroidal antiinflammatory drugs (odds ratio [OR] 3.76, p = 0.037), cancer chemotherapy (OR 13.56, p = 0.005), and preoperative renal dysfunction (OR 4.72, p = 0.018) were independent predictors. A potential scoring model could be created using these three parameters, and the number of risk factors correlated with the likelihood of developing a residual abscess (0 vs. 1 vs. ≥2; 6.2% vs. 29.4% vs. 50.0%, p < 0.001). From a bacteriological point of view, the presence of Enterococcus in the ascites culture was closely related to its occurrence with 100% probability. Moreover, regarding early detection of this complication, C‐reactive protein on postoperative d 5 had the highest predictive ability with an area under the curve of 0.818.ConclusionThe risk of residual abscess formation after surgical treatment of GD perforation can be assessed utilizing both preoperative and postoperative information.

Minimal Risk of Biliary Tract Complications, Including Hepatic Abscess, After Transarterial Embolization for Hepatocellular Carcinoma Using Concentrated Antibiotics Mixed with Particles.

To assess the incidence of biliary complications, cholecystitis, and abscess formation in HCC patients following transarterial embolization (TAE) using particles mixed with concentrated antibiotics. Retrospective review of HCC patients treated with embolization over a 10-year period revealed 499 procedures in 257 patients. TAE was performed with particles mixed with concentrated antibiotics in addition to IV antibiotics. All follow-up imaging after treatment was retrospectively reviewed for the development of bilomas, biliary strictures, acute cholecystitis, and hepatic abscess. Clinical notes and laboratory tests were also reviewed. Mean follow-up duration was 18.2months. In total, there was one biliary complication consisting of biloma formation. This patient had subsegmental hepatic infarction identified on imaging 8days post-embolization in the setting of subsegmental portal vein thrombus, with subsequent biloma development. There were no cases of new biliary strictures in the embolized portion of the liver at any point after treatment. One patient developed acute gangrenous cholecystitis 10days post-procedure. No patients developed a hepatic abscess, although 10 patients had bilioenteric anastomoses or incompetent sphincters of Oddi. Biliary complications and cholecystitis occurred extremely rarely after TAE, at a markedly lower rate than historical data on TACE. Despite significant risk factors for abscess formation in 10 patients, TAE with particles mixed with concentrated antibiotics resulted in zero abscesses, in contrast to a very high rate after TACE in the literature.

Risk factors for wound complications in head and neck reconstruction: 773 free jejunal reconstruction procedures after total pharyngolaryngoesophagectomy

Most studies that examined risk factors for wound complications after head and neck reconstruction analyzed various complications collectively. Moreover, they included a wide variety of resection areas and reconstruction materials. To overcome these limitations, both the resection area and reconstruction method were constrained in the present study. Patients who underwent free jejunal graft reconstruction after pharyngolaryngoesophagectomy for hypopharyngeal cancer were enrolled. The outcomes of interest were abscesses, fistulas, and cervical skin flap necrosis. Abscesses, fistulas, and cervical skin flap necrosis developed in 19.3%, 11.3%, and 8.2% of 773 patients, respectively. A significant relationship was found between use of an open drain and abscess formation and between a longer operation time and cervical skin flap necrosis. Our findings suggest that use of an open drain, cardiovascular disease, and a longer operation time are significant risk factors for abscess formation, fistula formation, and cervical skin flap necrosis, respectively.

Masquerading as Malignancy: A Case of a Misleading Gallbladder Abscess

Introduction: A gallbladder mass should always concern a clinician for malignancy. However, clinical and radiologic data are surprisingly similar for benign and malignant disease. A few cases of gallbladder abscesses mimicking cancer have been described in the setting of cholecystitis or as a complication of spilled gallstones after laparoscopic cholecystectomy. Our case is unique, as our patient had no known risk factors for abscess formation. Case: A 64-year old male presented with intermittent abdominal pain and fevers, night sweats, and 30-pound weight loss over 2 months. Physical exam was unremarkable. Lab studies showed mild leukocytosis with WBC 13.6 and normal LFTs. CT scan revealed a gallbladder mass with pneumobilia. MRI showed a diffusely thickened gallbladder with fistulization to the transverse colon, suspicious for malignancy. CA-19-9 was normal. PET-CT depicted increased uptake in the area of the gallbladder and hepatic flexure. Pre-operative diagnosis of gallbladder cancer was made and a radical en bloc cholecystectomy with partial hepatectomy and partial transverse colectomy was performed. Post-operative pathology revealed no malignancy, but rather an abscess involving the liver, gallbladder, and colon. Discussion: Diagnosis of gallbladder pathology is challenging due to nonspecific clinical and radiologic findings. The four distinct radiologic patterns are polypoid gallbladder mass, focal or diffuse gallbladder wall thickening, polypoid bile duct mass, and focal bile duct stricture. These can occur with benign or malignant lesions. Specificity of US, CT and MRI to distinguish benign from malignant gallbladder lesions is poor. Additionally, PET yields false positives in inflammation. Known masqueraders in the gallbladder are adenomyomatosis, xanthogranulomatous cholecystitis, and tuberculoid granulomatosis. Our patient had an intact gallbladder with no signs of cholelithiasis, cholecystitis, or other chronic process. Further review of his case revealed hepatic flexure diverticula on CT and foreign body giant cells in the abscess on pathology suggesting a possible perforated diverticulitis with fistulization to the gallbladder as the etiology of our patient's abscess. The best means of accurately diagnosing gallbladder pathology remains to be determined. Clinicians must beware of radiologic limitations and hold a high index of suspicion for malignancy in the right clinical context, but be mindful of mimicry as well.Figure 1Figure 2

Acute bacterial prostatitis and abscess formation.

BackgroundThe purpose of this study was to identify risk factors for abscess formation in acute bacterial prostatitis, and to compare treatment outcomes between abscess group and non-abscess group.MethodsThis is a multicenter, retrospective cohort study. All patients suspected of having an acute prostatic infection underwent computed tomography or transrectal ultrasonography to discriminate acute prostatic abscesses from acute prostatitis without abscess formation.ResultsA total of 31 prostate abscesses were reviewed among 142 patients with acute prostatitis. Univariate analysis revealed that symptom duration, diabetes mellitus and voiding disturbance were predisposing factors for abscess formation in acute prostatitis. However, diabetes mellitus was not related to prostate abscess in multivariate analysis. Patients with abscesses <20 mm in size did not undergo surgery and were cured without any complications. In contrast, patients with abscesses >20 mm who underwent transurethral resection had a shorter duration of antibiotic treatment than did those who did not have surgery. Regardless of surgical treatment, both the length of hospital stay and antibiotic treatment were longer in patients with prostatic abscesses than they were in those without abscesses. However, the incidence of septic shock was not different between the two groups. A wide spectrum of microorganisms was responsible for prostate abscesses. In contrast, Escherichia coli was the predominant organism responsible for acute prostatitis without abscess.ConclusionImaging studies should be considered when patients with acute prostatitis have delayed treatment and signs of voiding disturbance. Early diagnosis is beneficial because prostatic abscesses require prolonged treatment protocols, or even require surgical drainage. Surgical drainage procedures such as transurethral resection of the prostate were not necessary in all patients with prostate abscesses. However, surgical intervention may have potential merits that reduce the antibiotic exposure period and enhance voiding function in patients with prostatic abscess.

Risk Factors Associated With Abscess Formation in Children 5 Years of Age and Younger.

From 1997 to 2009, hospitalization rates have doubled for pediatric patients with soft tissue abscesses requiring incision and drainage. Despite this increasing national burden, few studies have been conducted to identify the risk factors associated with abscess formation. Our study evaluates a collection of physiological and lifestyle parameters that may serve as risk factors for abscess formation among pediatric patients 5 years of age or younger. Our results indicate family history and age 2 years and younger are associated with higher risk of abscess formation. Furthermore, methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus were prevalent pathogens associated with abscess in our study group. Pediatricians may employ these novel parameters to educate parents and/or guardians of high-risk groups on preventing abscess formation to alleviate the burden of incision & dragining requiring abscess on health care costs.

Risk and Management of Intra-Abdominal Abscess in Crohn's Disease Treated with Infliximab

Background and Aims: Infliximab (IFX) is a monoclonal antibody used to treat patients with Crohn's disease (CD). Intra-abdominal abscess formation is a major complication of CD with negative effects on patient prognosis. We have analyzed risk factors for abscess formation in CD patients treated with IFX. Methods: CD patients who received IFX between January 2000 and April 2011 at Keio University Hospital were analyzed retrospectively. Risk factors for abscess formation were assessed by univariate and multivariate logistic regression analyses. Results: Intra-abdominal abscess was seen in 15 of 258 patients. Univariate analyses showed serum C-reactive protein (CRP) concentration at 14 weeks after initiation of IFX (p = 0.021), serum albumin concentration at week 0 (p = 0.022) and week 14 (p = 0.004), the presence of anal lesions (p = 0.036), progression of intestine deformation (p = 0.015) and early loss of response to IFX (p < 0.0001) to be risk factors. Multivariate analysis showed that CRP concentration at 14 weeks [odds ratio (OR) 1.361] and loss of IFX response within 6 months (OR 5.361) were independent risk factors. Conclusions: Abscess formation should be suspected in patients with symptoms of CD recurrence during IFX therapy. Uncontrolled CRP concentration and early loss of response to IFX are risk factors.

Risk factors for abscess formation in patients with superficial cellulitis (erysipelas) of the leg

Superficial cellulitis of the leg (erysipelas) is a frequent skin infection. Abscess formation is the most frequent local complication. Determinants of abscess formation in patients with leg cellulitis have not yet been clearly established. To assess the risk factors for abscess formation in patients with leg cellulitis. The clinical, biological and bacteriological records of all patients referred to the dermatology department of a university hospital for superficial cellulitis of the leg during a 3-year period were retrospectively reviewed. Using univariate and multivariate analysis, patients' main characteristics at baseline were compared between the group of patients who developed abscess and the group who did not. A total of 164 patients (93 female, 71 male), mean age 65±18 years, were included. Abscess occurred in 13 cases (8%). The following general factors were positively associated with abscess formation: male sex, smoking, alcohol abuse and delayed introduction of antibiotic treatment. Based on multivariate analysis, only chronic alcohol abuse [odds ratio (OR) 4·3, 95% confidence interval (CI)1·08-20·57] and delayed antibiotic treatment initiation (OR 1·4, 95% CI 1·02-2·04) remained independently associated with abscess formation. Alcohol abuse and delayed initiation of antibiotic treatment are risk factors for abscess formation in patients with cellulitis of the leg. Patients with these predictors must be monitored carefully for abscess formation.

GSBL üreten Klebsiella pneumoniae’nın neden olduğu komplike dev karaciğer apsesi olgusu

A case report of complicated giant liver abscess caused by ESBL producing Klebsiella pneumoniae Liver abscess most frequently occurs secondary to biliary gland and biliary tract diseases with a clinical picture with fever, nausea and vomiting, and right upper abdominal pain. Diabetes mellitus and immunosuppression are risk factors for abscess formation and other complications. Besides technological innovations, radiological technics and invasive procedures have been developed for diagnosis and this has led to decrease in the mortality and morbidity of liver abscess. Abdominal ultrasonography is a frequently used method but, computed tomography is the gold standard for diagnosis. In this study, a 67-year-old diabetic male patient who developed complicated liver abscess after laparoscopic cholesystectomy caused by