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终末期肾病血液透析患者的髂腰肌脓肿

Iliopsoas Abscess in Hemodialysis Patients With End-Stage Kidney Disease.

作者信息

Kawai Yusuke, Banshodani Masataka, Moriishi Misaki, Sato Tomoyasu, Shintaku Sadanori, Masaki Takao, Kawanishi Hideki

机构信息

Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.

Radiology, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.

出版信息

Ther Apher Dial. 2019 Dec;23(6):534-541. doi: 10.1111/1744-9987.12801. Epub 2019 Apr 25.

Abstract

Iliopsoas abscess in HD patients is rare. We examined nine HD patients with iliopsoas abscess (six men and five diabetes mellitus cases) treated between 2005 and 2015. Mean age and dialysis vintage at onset were 72 years and 109 months, respectively. Of the nine patients, four had lumbar orthopedic diseases, and two had all components of the classic triad of iliopsoas abscess at onset. All nine patients underwent percutaneous drainage, while seven underwent antimicrobial therapy. The most common pathogenic bacterium was methicillin-resistantStaphylococcus aureus(MRSA) (n = 5). Four patients had multilocular recurrence on the same side as the initial abscess and did not undergo CT before drainage catheter removal. Five patients died in the hospital, in which three died due to infectious diseases by MRSA. We suggest percutaneous drainage as the first-line therapy for HD patients with iliopsoas abscess and recommend combining antimicrobial therapy for MRSA, because of poor prognosis.

摘要

血液透析(HD)患者发生髂腰肌脓肿较为罕见。我们研究了2005年至2015年间接受治疗的9例患有髂腰肌脓肿的HD患者(6名男性,其中5例患有糖尿病)。发病时的平均年龄和透析时间分别为72岁和109个月。9例患者中,4例患有腰椎骨科疾病,2例在发病时具备髂腰肌脓肿经典三联征的所有表现。所有9例患者均接受了经皮引流,7例接受了抗菌治疗。最常见的病原菌是耐甲氧西林金黄色葡萄球菌(MRSA)(n = 5)。4例患者在初始脓肿同侧出现多房性复发,且在拔除引流导管前未进行CT检查。5例患者在医院死亡,其中3例死于MRSA感染性疾病。由于预后较差,我们建议将经皮引流作为HD患者髂腰肌脓肿的一线治疗方法,并推荐联合针对MRSA的抗菌治疗。

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