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PubMedDate not supplied

Bacteroides fragilis-induced intra-abdominal abscess in an experimental model treated with telithromycin (HMR 3647).

BACKGROUND: Telithromycin (HMR 3647), a novel ketolide, is known to have activity against Bacteroides fragilis in vitro. METHODS: We tested this ketolide in an animal model of intra-abdominal abscess produced by intraperitoneal injection of B. fragilis with sterile feces and BaSO(4) mixture. Telithromycin was tested at two doses, 1. 25 and 2.0 mg/dose twice daily, and compared with clindamycin, cefotetan or metronidazole, all given at 2.0 mg/dose twice daily for 10 days. Absence of bacteria at the infected site was considered a cure and a positive culture considered a failure. RESULTS: The cure rate was 18% (5/28) on saline therapy, 74% (20/27) on telithromycin and 82% (23/28) on clindamycin, whereas it was 61% (17/28) on metronidazole and 59% (16/27) on cefotetan therapy. A high tissue antibiotic concentration (3-5 times the MIC) of telithromycin was found and this is presumably related to its superior efficacy. Delayed therapy initiated 7 days after infection instead of immediate therapy cured only 32% of the animals treated. The lower dose of telithromycin (1.25 mg/dose twice daily) was as effective as the higher dose (2 mg/dose twice daily). CONCLUSIONS: We found that telithromycin is as effective as clindamycin and more effective than metronidazole and cefotetan in this experimental model. These results suggest that telithromycin may be tested in future for the treatment of B. fragilis infections in humans.

Abdominal Abscess↗
PubMed1975

Giant horseshoe intra-abdominal abscess.

A study of 12 patients with giant horseshoe abscess of the abdominal and pelvic cavities seen at the Surgical Services of the University of Cincinnati Medical Center has emphasized the complexity and bizarre nature of these lesions. These infections represented a huge abscess or series of communicating abscesses extending from one subphrenic space along the corresponding paracolic gutter into the pelvis, up and along the opposite paracolic space, and into the other subphrenic space. Since these lesions occurred infrequently, they were often not recognized until they had become far advanced and had produced profound effects on the patients. The diagnosis was difficult and obscured by various factors including the postoperative state after laparotomy for complex diseases or serious injuries of the biliary tract, the genitourinary tract, or the alimentary tract. An important etiologic component of the formation of these giant abscesses was the continuing escape and collection of large volumes of fluid resulting from lesions of the biliary tract, postoperative hemorrhage, or an unrecognized large perforated peptic ulcer. Nine patients were treated successfully and 3 died. The many diagnostic and therapeutic problems presented by the patients with this interesting and complex lesion have emphasized the importance of earlier and more accurate diagnosis, early and adequate surgical drainage, intelligently applied antibiotic therapy and appropriate supportive treatment. Failure to recognize and drain effectively each of the component sections of this lesion led to continuing sepsis with prolonged morbidity, progressive debility, and death.

Abdomen↗
PubMed1993

[Helium-neon laser in the combined treatment of postoperative abdominal abscess].

The results of treatment of 116 patients with a residual abscess of the abdominal cavity, including 59 who underwent complex treatment with the use of a helium-neon laser radiation, have been analysed. The use of intracavitary laser therapy in combination with active drainage of an abscess stimulated the reparative processes in the organism, permitted to improve the results of treatment, reduce lethality from 15.3 to 5.3% and mean duration of treatment--from 37.1 to 28.8 days.

Abscess↗
PubMed1999

Activities of the oxazolidinones linezolid and eperezolid in experimental intra-abdominal abscess due to Enterococcus faecalis or vancomycin-resistant Enterococcus faecium.

The in vivo effectiveness of oxazolidinones eperezolid (U-100592) and linezolid (U-100766) against one strain each of Enterococcus faecalis and vancomycin-resistant Enterococcus faecium was examined in a rat model of intra-abdominal abscess. MICs of both drugs were 2 microg/ml for each strain. At doses of 25 mg/kg of body weight twice daily intravenously or orally, linezolid produced small but statistically significant reductions in abscess bacterial density for E. faecalis. The reduction in viable cells observed would not likely be clinically relevant. Eperezolid was ineffective at this dose. At a dosage of 100 mg/kg/day, linezolid treatment led to an approximately 100-fold reduction in viable cells per gram of abscess. Against E. faecium infections, intravenous eperezolid and oral linezolid were effective, reducing densities approximately 2 log(10) CFU/g. Both oxazolidinones demonstrated activity against enterococci in this model. However, results were modest with the dosing regimens employed.

Abdominal Abscess↗
PubMed1988

Improved treatment of intra-abdominal abscess. A result of improved localization, drainage, and patient care, not technique.

Outcome in patients with abdominal abscesses treated at the University of Pennsylvania, Philadelphia, between 1973 and 1978 (group 1) was compared with that in patients treated between 1981 and 1986 (group 2). Mortality was less in group 2 patients (21% vs 39% in group 1). The decrease in mortality in group 2 was accompanied by a greater percentage of successful predrainage localization (74% vs 55% in group 1), successful initial drainage (76% vs 55% in group 1), and decreased predrainage organ failure (23% vs 52% in group 1). Because failure of initial drainage and predrainage organ failure were associated with increased mortality, improvement in both of these criteria contributed substantially to the lower mortality in group 2 patients. There were no differences in mortality, in initial success in drainage, or in length of hospital stay when 29 group 2 patients who underwent percutaneous drainage were compared with 37 patients who underwent surgical drainage. Mortality (22% vs 21%) and initial success (78% vs 72%) were similar for patients who underwent surgical and percutaneous drainage, respectively. We conclude that initial success in localization and drainage of the abscess is more important than whether drainage is surgical or percutaneous.

Abdomen↗
PubMed1991

Leucocytes labelled with 99mTc-HMPAO in the detection of abdominal abscesses.

To assess the value of 99mTc-HMPAO-labelled-leucocyte scintigraphy in the detection of abdominal abscesses, the results of 74 examinations in 69 patients suspected of having abscesses on clinical grounds were reviewed retrospectively. Of a final total of 29 abscesses in 28 patients, leucocyte scanning diagnosed 26, giving a sensitivity, specificity, and accuracy of 90%, 91%, and 91%, respectively. In 22 patients abscesses were diagnosed within 30 min. In 13 of the 74 examinations (18%) an infection or inflammatory lesion other than an abscess was diagnosed. 99mTc-HMPAO-labelled-leucocyte scintigraphy is an accurate and rapid method of diagnosing abscesses in acutely ill patients.

Abdomen↗
PubMed1990

An objective appraisal of the role of computed tomographic (CT) guided drainage of intra-abdominal abscesses.

Computed tomographic (CT) guided drainage is an important tool in the treatment of intra-abdominal abscess. Its most important role is in the treatment of small, unilocular, well-placed abscesses. Success rates in our experience diminish considerably in abscesses involving necrotic tumors or those infected with yeast. As is frequently characteristic of new technologic procedures, the initial evaluation of the success rate of the procedure is overly optimistic. The procedure carries a considerable complication rate (13%) and mortality rate (15%). Most importantly, success is usually evident early; within the first 24 to 48 hours. After this length of time, careful evaluation to consider further treatment should be contemplated.

Abdomen↗
PubMed1983

New approaches in treating abdominal abscesses.

Ultrasonography, computed tomography and radionuclide scintigraphy are changing the management of patients with intra-abdominal abscesses. Traditional surgical incision and drainage may not be necessary in all cases. Percutaneous catheter drainage using radiologic techniques has a high success rate. Although there are factors that preclude the use of percutaneous catheter drainage of an abscess, it nonetheless may be an alternative in certain situations.

Abdomen↗
PubMed1997

Efficacies of piperacillin-tazobactam and cefepime in rats with experimental intra-abdominal abscesses due to an extended-spectrum beta-lactamase-producing strain of Klebsiella pneumoniae.

The in vivo activities of piperacillin-tazobactam and cefepime were compared with those of ticarcillin-clavulanate, ceftazidime, cefotaxime, and imipenem in a rat model of intra-abdominal abscess with a strain of Klebsiella pneumoniae elaborating an extended-spectrum beta-lactamase (TEM-26). With the exception of ceftazidime, all of the antimicrobial agents significantly reduced bacterial counts within abscesses at the end of therapy compared with those in untreated controls. Residual viable cell counts (mean +/- standard deviation in log10 CFU/gram) were as follows: control, 8.76 +/- 0.97; ceftazidime, 8.00 +/- 0.76; piperacillin-tazobactam, 3.87 +/- 1.72; ticarcillin-clavulanate, 3.74 +/- 1.34; cefepime, 3.15 +/- 1.19; cefotaxime, 2.61 +/- 0.77; imipenem, 2.41 +/- 0.93. Imipenem was more effective than either of the inhibitor combinations (P < 0.05). Cefotaxime was unexpectedly effective given its poor in vivo activity against this organism in our earlier studies, which used a different dose and total duration of therapy (L. B. Rice, J. D. C. Yao, K. Klimm, G. M. Eliopoulos, and R. C. Moellering, Jr., Antimicrob. Agents Chemother. 35:1243-1244, 1991). These observations suggest that the effectiveness of cephalosporins in the treatment of experimental infections caused by extended-spectrum beta-lactamase-producing K. pneumoniae may be highly dependent on dosing regimens, even for a specific organism and site of infection.

Abdominal Abscess↗
PubMed2004

Therapeutic efficacy of moxifloxacin, a new quinolone, in the treatment of experimental intra-abdominal abscesses induced by Bacteroides fragilis in mice.

Moxifloxacin, a new quinolone, is effective in vitro against several anaerobic bacteria including Bacteroides fragilis, but its in vivo activity against anaerobic infections is not known. In this study, we evaluated the in vivo activity of moxifloxacin in the treatment of experimentally induced intra-abdominal abscesses (IAA) caused by B. fragilis. For comparison, clindamycin, metronidazole, and levofloxacin were used, and saline for control. Absence of bacteria (sterile) in the abscess pus was required to call it a cure. Mice were intraperitoneally injected with B. fragilis plus sterile rat feces and barium sulfate. Animals were treated with moxifloxacin (40 mg/kg/b.i.d.), clindamycin (75 mg/kg/b.i.d.), levofloxacin (40 mg/kg/b.i.d.) or metronidazole (75 mg/kg/b.i.d.) for 10 days. The cure rate was 12% in controls on saline therapy, 57% on metronidazole, 67% on levofloxacin, 73% on moxifloxacin and 79% on clindamycin. The therapeutic efficacy of moxifloxacin in this B. fragilis infection was not significantly different from that observed with clindamycin. By virtue of its established efficacy on gram-negative aerobic bacteria and the observed in vivo efficacy on B. fragilis, moxifloxacin can be evaluated in the treatment of clinical anaerobic infections.

Abdominal Abscess↗
PubMed1982

Percutaneous radiographically guided catheter drainage of abdominal abscesses.

We performed computed body tomography and ultrasound-guided percutaneous catheter drainage in 45 cases of abdominal abscess. Evacuation of the cavity was achieved in 40 cases (89%), eliminating the need for surgery in 34 patients. There were six recurrent abscesses, all due to fistulous communications or recurrent infected tumor. Major complications were a lacerated mesenteric vessel and a small-bowel fistula. Drainage catheters were removed an average of seven days after insertion. In many cases, guided percutaneous radiological drainage is an effective alternative to operative therapy, especially in severely ill patients.

Abdomen↗
PubMed2006

Intra-abdominal abscess in a patient with tumour necrosis factor receptor-associated periodic syndrome.

Tumour necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is an autoinflammatory disorder characterized by periodic attacks of fever and inflammation, due to mutations in the gene coding for the TNF type I receptor (TNFRSF1A). A 16-year-old patient with the diagnosis of TRAPS was admitted to hospital because of fever and abdominal pain. Initially, the symptoms were interpreted as manifestations of another TRAPS attack, but the patient's condition worsened, despite treatment with corticosteroids and antibiotics. A repeated computer tomography revealed an intra-abdominal abscess, which necessitated urgent surgical intervention. This case stresses the importance of differential diagnostic vigilance when dealing with patients with rare genetic diseases.

Abdominal Abscess↗
PubMed1986

Percutaneous catheter drainage of abdominal abscesses.

This paper presents a study of 45 patients who had percutaneous catheter drainage of 52 intra-abdominal abscesses. In 37 patients this was the only treatment necessary; the other 8 needed further surgery to correct the cause of the abscess or treat concurrent surgical disease. The catheter complication rate was 3.8%.

Abdomen↗
PubMed1980

Intra-abdominal abscess and fungemia caused by candida krusei.

A 73-year-old man with chronic lymphocytic leukemia experienced an intra-abdominal abscess caused by Candida krusei. Treatment with drainage alone led to dissemination of the infection and resultant C krusei fungemia. The fungemia responded to therapy with amphotericin B, but the patient died of multisystem failure. We stress the rarity of intra-abdominal infection and fungemia with this organism and the necessity for treatment of candidal intra-abdominal infection with antifungal agents. X

Abscess↗
PubMed1999

[Percutaneous drainage of abdominal abscess. A clinical case and issues of operative ultrasonography in urology].

Percutaneous drainage of intrabdominal abscesses currently is a well established technique. The use of ultrasound, ever more frequently utilized in urology department, made urologists autonomous in ultrasound diagnosis and operative stage. We report on a patient admitted to emergency department in whom acute prostatitis was diagnosed. Urological consultation was obtained. The ultrasound examination performed, permitted to reveal the real syntomatology origin and to make an evaluation about the possible application of ultrasound in diagnosis and treatment of abdominal abscesses. This was also an occasion to re-examine some not urological ultrasound cases and their treatment. We believe that, also for the urologists, morphological knowledge of most frequent abdominal pathologies, visible by ultrasound, is useful to avoid diagnostic mistakes and useless and hazardous treatments. In our experience we confirm that percutaneous and non invasive techniques, if well utilized, have a good cost/benefit ratio. The percutaneous treatment is also useful to convert an urgent surgical operation into a well established and programmed one.

Abdominal Abscess↗