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Marianne E. Cinat, MD; Samuel E. Wilson, MD; Adnan M. Din, MD

Arch Surg. 2002;137:845-849.

Hypothesis  Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD).

Methods  We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome.

Results  The study included 96 patients (59% men; mean ± SD age, 48 ± 17 years; mean ± SD Acute Physiology and Chronic Health Evaluation II score, 7.4 ± 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P = .02). Postoperative abscess (P = .04) was an independent predictor of successful outcome.

Conclusions  Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.

From the Department of Surgery, University of California, Irvine Medical Center, Orange.

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