Psoas Abscess: A Primer for the Internist

, Department of Internal Medicine, Lincoln Health Center and Durham Regional Hospital, Durham, NC

South Med J. 2001;94(1) 

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Treatment involves the use of appropriate antibiotics, as well as drainage of the abscess. Knowledge of common pathogens should guide initial choice of antibiotics. Adjustments should be based on report of abscess fluid culture and sensitivity testing. It has been suggested that in cases of psoas abscess believed to be primary, antistaphylococcal antibiotic therapy should be started before final bacteriologic diagnosis.[1] However, the identification of nonstaphylococcal organisms in some patients with primary psoas abscess and the identification of staphylococcus in patients with secondary psoas abscess[3] make it prudent in all cases of psoas abscess to start treatment with broad spectrum antibiotics pending final bacteriologic diagnosis. Coverage should include staphylococcal and enteric organisms, for which agents such as clindamycin, antistaphyloccocal penicillin, and an aminoglycoside may be used.[11] Less cumbersome regimens can be easily formulated. Drainage of the abscess may be done through CT-guided percutaneous drainage or surgical drainage. Percutaneous drainage is much less invasive and is effective for draining uniloculated and multiloculated psoas abscesses.[12] It is technically similar to open surgical drainage, and it has been advocated as the drainage method of choice.[13] Surgical drainage is associated with shorter hospital stay (15.9 vs 28.5 days).[3] Surgical drainage may be ideal for patients with underlying Crohn's disease or other gastrointestinal diseases. In these patients, performing a single operation to drain abscess and resect diseased bowel is desirable.[15] An occasional patient will require multiple operations[15] or repeated percutaneous drainage before the abscess resolves. Abscess drainage needs to be continued until obliteration of the abscess cavity occurs and there is evidence of clinical improvement. Parameters that can be used to determine clinical recovery include defervescence and normalization of the white blood cell (WBC) count, as well as subjective improvement. The duration of antibiotic therapy should be individualized. Antibiotics are sometimes continued up to 2 weeks after complete abscess drainage.

The following report describes a case of psoas abscess in a patient who was also found to have HIV infection.


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