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

TY - JOUR

T1 - Psoas abscess management

T2 - A multimodal approach to treatment modalities, predictors of clinical outcomes and a novel treatment algorithm"

AU - Khalil, Tarek

AU - Ismahel, Nadeen

AU - Lucocq, James

AU - Ng, Lea

AU - Muthukumarasamy, Girivasan

N1 - Publisher Copyright: © 2025 The Authors.

PY - 2026/2

Y1 - 2026/2

N2 - 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.

AB - 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.

KW - Clinical outcomes

KW - IR drainage

KW - Microbiological findings

KW - Open surgery

KW - Psoas muscle abscess

KW - Recurrence predictors

UR - https://www.scopus.com/pages/publications/105027923794

U2 - 10.1016/j.surge.2025.12.002

DO - 10.1016/j.surge.2025.12.002

M3 - Article

C2 - 41429637

SN - 1479-666X

VL - 24

SP - 43

EP - 49

JO - Surgeon

JF - Surgeon

IS - 1

ER -