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PubMed1994

Aztreonam vs. gentamicin in experimental peritonitis and intra-abdominal abscess formation.

The activity of gentamicin is known to be decreased in acidic environments, and both the peritoneum during peritonitis and the interior of abscesses have been shown to be acidic and hypoxic. The activity of beta-lactam antibiotics is felt to be relatively less diminished under the same circumstances. We determined that the minimum inhibitory concentration of gentamicin against one pathogenic strain of Escherichia coli increased eight-fold, to 8 mugm/mL, when testing conditions were changed from normoxic and neutral to hypoxic and acidic, whereas the MIC of aztreonam doubled under the same conditions, to 0.25 mugm/mL. In further experiments in a murine model of mixed Escherichia coli/Bacteroides fragilis intra-abdominal abscesses, we demonstrated that a combination of aztreonam and clindamycin was superior to a combination of gentamicin and clindamycin in terms of completely preventing abscess formation (33% vs. 0%) and eliminating Escherichia coli from abscesses that did form (100% vs. 61%).

Abdominal Abscess↗
PubMed1984

[Radiologic diagnosis of intra-abdominal abscesses by stepwise use of imaging procedures].

Plain radiographs of the abdomen in supine and left decubitus position were combined with additional contrast medium examinations, ultrasonography and computed tomography and used for diagnosis in 47 patients with surgically verified abdominal abscesses. Typical abscess signs were analysed to establish the stepwise use of imaging procedures. Diagnosis of an intraperitoneal or retroperitoneal abscess can be made in over 50% of the cases by accurate interpretation of abdominal plain films. If combined with ultrasonography, diagnosis is possible in even almost 90% of the cases. Computed tomography may additionaly show the exact localisation and extension of the lesion and is mainly used in planning further surgical treatment.

Abscess↗
PubMed1994

Structural characteristics of polysaccharides that induce protection against intra-abdominal abscess formation.

Bacteroides fragilis is the anaerobe most commonly isolated from clinical cases of intra-abdominal sepsis. In a rodent model of this disease process, intraperitoneal injection of the capsular polysaccharide complex (CPC) from B. fragilis provokes abscess formation, while subcutaneous administration of this complex confers protection against B. fragilis-induced intra-abdominal abscesses. The CPC consists of two discrete polysaccharides, polysaccharides A and B (PS A and PS B), each possessing oppositely charged structural groups critical to the ability of these carbohydrates to induce the formation of abscesses. Other bacterial polysaccharides that possess oppositely charged groups (such as the group antigen or capsular polysaccharide from Streptococcus pneumoniae type 1 strains) also exhibited potent abscess-inducing capabilities. We report here that positively and negatively charged groups on polysaccharides are also essential for inducing protection against abscess formation. Vaccination of rats with B. fragilis PS A, PS B, or the S. pneumoniae type 1 capsule protected against intra-abdominal abscesses subsequent to intraperitoneal challenge with each of these polysaccharides. Chemical conversion of the free amino or carboxyl groups on PS A to uncharged N-acetyl or hydroxymethyl groups, respectively, abrogated the ability of this polymer to confer protection against polysaccharide-mediated abscess formation. Adoptive transfer of splenic T cells from polysaccharide-vaccinated rats to naive animals demonstrated that T cells mediated this protective activity. T cells transferred from animals vaccinated with a polysaccharide repeating unit (Salmonella typhi Vi antigen) that normally contains one carboxyl group but was chemically converted to a polymer that possesses both free amino and carboxyl groups (accomplished by de-N-acetylating the Vi antigen) protected naive T-cell recipients against polysaccharide-induced abscesses. These results demonstrate that a distinct structural motif associated with the B. fragilis polysaccharides is necessary for induction of protective immunity against abscess formation associated with intra-abdominal sepsis. However, protection is not antigen specific in a traditional sense. Rather, the protective ability of these structurally dissimilar polysaccharides is conferred by, and perhaps specific for, a motif of oppositely charged groups.

Abdominal Abscess↗
PubMed1992

Evaluation of temafloxacin in a rat model of intra-abdominal abscess.

The in-vitro activity of temafloxacin, a new fluoroquinolone, was evaluated in an experimental model of intra-abdominal abscess in rats. Mixed aerobic-anaerobic infection was induced by intraperitoneal implantation of gelatin capsules containing Bacteroides fragilis, Escherichia coli, and sterile rat faeces. Temafloxacin was highly active with a 90.9% cure rate in comparison with no treatment (no cures; P less than 0.0001), and as active as a combination of clindamycin and gentamicin (100% cure rate; P greater than 0.05). Temafloxacin (12 mg/dose) gave rise to serum concentrations that exceeded the MIC values of both microorganisms for at least 8 h.

Abdomen↗
PubMed1992

Pathogenicity of Bacteroides fragilis group in rat intra-abdominal abscesses.

Attempts were made to study the pathogenicity of some strains of Bacteroides fragilis group in the rat intra-abdominal abscess model. Multiple intraabdominal abscesses were produced in 50 to 70% of animals when an inoculum containing 10(9) CFU/ml of any of the five species of Bacteroides fragilis group was injected. Rising homologous antibody titers determined by indirect fluorescent antibody test were observed till the 3rd week when tested last, indirectly confirming the multiplication of the organisms as also evident by viable count of bacteria in the abscesses. In some cases in addition to inoculated organisms some intestinal bacteria like Escherichia coli, Proteus mirabilis and Streptococcus spp. were also recovered from the abscess pus. Studies with the electron microscope showed presence of capsular polysaccharide only in Bacteroides fragilis and Bacteroides thetaiotaomicron. It was doubtful in Bacteroides distasonis and absent in Bacteroides ovatus and Bacteroides vulgatus, suggesting that virulence factor beside the capsular polysaccharide may be playing a role. Further studies are required to investigate the virulence factor responsible for the pathogenicity of noncapsulated species.

Abdomen↗
PubMed2004

Abdominal abscess and Hafnia alvei septicemia occurring during the aplastic phase after autologous stem-cell transplantation in a patient with diffuse large B-cell lymphoma.

Hafnia alvei is a motile gram-negative bacterium that is rarely isolated from human specimens, but that sometimes can be found as part of the gastrointestinal flora. Here we report a rare case of Hafnia alvei septicemia with an abdominal abscess in a 60-year-old woman with diffuse large B-cell lymphoma involving the spleen, liver, and then lymph nodes. She initially received a splenectomy, and, over a 2-year period, four courses of chemotherapy. After achieving complete remission status, she underwent autologous peripheral blood stem-cell transplantation (PBSCT). During the aplastic phase following transplantation, the patient developed fever, diarrhea, and abdominal pain, with blood cultures positive for Hafnia alvei and an abscess in the splenic recess. Considering the high surgical risk, the infection was treated, successfully, with antibiotics (imipenem/cilastatin), without surgery or computed tomography (CT)-guided percutaneous drainage. Infections due to Hafnia alvei are rare, and this is the first reported case of Hafnia alvei septicemia in an adult hematologic patient undergoing a stem-cell transplantation procedure.

Abdominal Abscess↗
PubMed1984

Radiologic aspects of diagnosis and treatment of abdominal abscesses.

The precise anatomic display by computed tomography and ultrasonography provides the guidance to make diagnostic needle aspiration a safe routine procedure. Percutaneous catheter drainage of abdominal abscesses now offers an alternative to surgery and has already become a well-established radiologic procedure in many centers.

Abdomen↗
PubMed1980

Diagnosis of abdominal abscesses with computed tomography, ultrasound, and 111In leukocyte scans.

Computed tomography (CT), ultrasound, and 111In-labeled leukocyte scans are all used in the evaluation of abdominal abscesses. In this study, 170 patients in whom one, two, or all three of these modalities were used retrospectively reviewed. Diagnostic accuracy of 96% for CT, 90% for ultrasound, and 92% for 111In leukocyte scans was achieved. It was often necessary to use more than one modality to arrive at a correct diagnosis. The advantages and disadvantages as well as the causes for false positive or false negative interpretations of each of these modalities are reviewed. Analysis of the different examinations resulted in a suggested sequence by which patients can be examined, based upon their clinical condition. Patients who are not critically ill and/or who have no localizing signs should be studied first with 111In-labeled leukocyte scans. If, however, localizing signs should or the patient's condition necessitates prompt intervention, CT or ultrasound should be the first study performed.

Abdomen↗
PubMed1991

Correlation of APACHE II score, drainage technique and outcome in postoperative intra-abdominal abscess.

The APACHE II Score was used to stratify retrospectively severity of illness in 91 patients postoperatively undergoing drainage of intra-abdominal abscesses. The method of initial abscess drainage (percutaneous or operative) was selected by the attending physician. The two groups of patients, those whose initial drainage was performed percutaneously versus operatively were similar with respect to age, sex, abscess location and, most importantly, severity of illness as assessed by the APACHE II score calculated on the day of their abscess drainage. Over-all, the mortality rate was 29 per cent (26 of 91 patients). Only 1.7 per cent of the patients with an APACHE II score of less than 15 died compared with 78 per cent when APACHE II was equal to or more than 15 (p less than 0.0001). Only 8 per cent of patients with APACHE II equal to or more than 15 undergoing percutaneous drainage survived compared with 30 per cent of patients who underwent surgical drainage procedures. While chi-square analysis demonstrated independence between outcome and drainage technique, outcome was dependent upon severity of illness (p less than 0.0005). Paradoxically, despite the attractiveness of a percutaneous technique for abscess drainage in the most ill patients, in this series, a better, although not statistically improved, chance for survival was noted with surgical treatment. We recommend that an objective severity scoring system be used whenever assessing results of treatment of intraabdominal infection and that surgical treatment not be avoided because the patient is considered to be too ill.

Abdomen↗
PubMed1988

Metastatic teratoma associated with an intra-abdominal abscess.

A case of metastatic testicular teratoma is reported where histological evidence of metastatic disease was obtained 12 years after orchidectomy. The patient had presented again 2 years earlier but the presence of a large intra-abdominal abscess delayed the diagnosis of recurrence. At no time were the serum levels of alpha-fetoprotein or beta human chorionic gonadotrophin elevated.

Abscess↗
PubMed1986

Zipper closure of the abdominal wall in the treatment of recurrent intra-abdominal abscesses.

Diffuse retroperitoneal soilage following rectal laceration with a blunt object resulted in significant morbidity despite prompt recognition, parenteral antibiotic administration, and early surgical intervention. A septic postoperative course was complicated by perforation of the third portion of the duodenum and a diffuse suppurative peritonitis with multiple intra-abdominal abscesses. Closure of the incision at reexploration was facilitated by sewing Marlex to the fascia while a centrally located nylon zipper allowed access to the peritoneal cavity for further explorations and eventual ablation of the septic process.

Abdomen↗
PubMed1987

Intra-abdominal abscess in the 1980s.

Prompt recognition, early localization, and adequate drainage have contributed to the decreased morbidity and mortality rates associated with intra-abdominal abscess in the last decade. The physical examination, ultrasonography, computed tomography, and radionuclide scans provide information that leads to early detection and localization of abscess in almost all patients. Percutaneous drainage should be the initial procedure unless specific indications for surgery exist.

Abdomen↗
PubMed1984

Therapeutic efficacy and pharmacokinetic properties of rifampicin in a Bacteroides fragilis intra-abdominal abscess.

The efficacy of rifampicin in treating a Bacteroides fragilis infection was investigated and compared to clindamycin and metronidazole in an experimental model of intra-abdominal abscess in mice. Rifampicin, when given subcutaneously, showed activity superior to that of clindamycin in reducing the incidence of abscess formation as well as the number of Bacteroides organisms recovered from the abscess, and rifampicin was comparable in efficacy to metronidazole when given orally at the same dose level. The comparative pharmacokinetic properties of rifampicin and clindamycin demonstrated that the peak serum and abscess levels reached with rifampicin were significantly higher than those of clindamycin. The half-life of rifampicin in serum and in the abscess was longer than that of clindamycin.

Abscess↗
PubMed1983

Intra-abdominal abscess formation in mice: quantitative studies on bacteria and abscess-potentiating agents.

A model of intra-abdominal (IA) abscess formation has been developed in mice. Intraperitoneal (i.p.) injection of a mixture of a potentiating agent (autoclaved colonic and caecal contents (ACC), 0.2 mg dry wt/mouse or sterile bran, 1 mg dry wt/mouse), Escherichia coli (1 X 10(6) colony forming units (cfu)/mouse) and Bacteroides fragilis (5 X 10(8) cfu/mouse) induced abscesses in 98% of mice inoculated. The abscesses persisted for at least 4 weeks in 60% of inoculated animals, and for 10 weeks in 36%. From 1 to 5 abscesses per mouse were found. Abscess formation was quantified by weighing the dissected abscesses and by culturing bacteria from them. Histologically, the abscesses were characterized by a central region of polymorphonuclear leucocytes, often with a thin mononuclear phagocyte infiltrate surrounding it, and an outer wall of vascularized connective tissue. Fluorescent antibody studies demonstrated that antigens from both bacterial species were distributed throughout the abscess. At the concentrations used, neither ACC nor sterile bran induced formation in the absence of viable bacteria.

Abdomen↗
PubMed1985

[Percutaneous drainage of abdominal abscesses. II. Value in comparison with septic surgery].

Based on the review of the literature and experience with own cases the current status of the therapy of abdominal abscesses by percutaneous catheter drainage is described. Indications, reasons for failure, complications, and mortality are presented in detail. Compared with surgery percutaneous abscess drainage (PAD) seems to have better results; however, this statement should be viewed with caution since the input of modern imaging techniques might have improved current surgical success rates. A trial of PAD can be recommended in all feasible cases because it offers high curability with little morbidity.

Abdomen↗