Psoas abscess management: A multimodal approach to treatment modalities, predictors of clinical outcomes and a novel treatment algorithm".

INTRODUCTION

Psoas muscle abscess (PMA) is a condition with high morbidity and mortality due to diagnostic delays and varied management strategies. Standardized treatment guidelines are lacking, leading to inconsistent clinical outcomes.

METHODS

This retrospective cohort study analysed 100 adult patients (≥18 years) diagnosed with PMA and treated at our Hospital, Dundee, between 2012 and 2022. Patients were categorized into three groups: conservative management (n = 39), CT-guided IR drainage (n = 51), and open surgery (n = 10). Data on demographics, laboratory values, microbiological findings, and clinical outcomes were collected. The primary outcome was recurrence of PMA. Secondary outcomes included mortality and factors predicting poor prognosis, such as comorbidities and microbiological findings. Statistical analyses included logistic regression and receiver operating characteristic (ROC) analysis.

RESULTS

Recurrence rates were highest in the conservative group (58.9 %) compared to the IR drainage (37.3 %, p = 0.01) and open surgery groups (30.0 %, p = 0.03). Negative cultures were associated with higher recurrence (p < 0.01) and mortality (p = 0.01). Staphylococcus aureus was the most frequently isolated pathogen and was linked to higher mortality (p = 0.01). Chronic kidney disease (CKD ≥3) (p = 0.01) and immune suppression (p = 0.03) were significant predictors of poor outcomes.

CONCLUSIONS

This study highlights the limitations of conservative management for PMA, particularly in patients with negative cultures, immunosuppression, or CKD ≥3. The findings support early image-guided drainage or surgical intervention in high-risk cases. A novel treatment algorithm is proposed to enhance clinical decision-making and improve outcomes.