1531. Psoas Abscess in Children: a Forgotten Diagnosis
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Posters
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  • Background: Psoas abscess (PA), mainly caused by S.aureus is uncommon condition in children. The absence of specific signs and symptoms delays diagnosis. We decide to characterize PA  clinical features in children in our setting

    Methods: Cross sectional study in an argentinian tertiary care pediatric center. Hospitalized children with PA at discharge, from Feb´13 – Feb´15. Demographic, clinical, image data and laboratory results were analyzed. EPI Info 3.2.2 vs was used

    Results:

    PA was diagnosed in 20 patients (pts). The hospitalization rate was 10.5/10,000(95%CI 6.4 – 16.3); female/male ratio 1.22:1. Age: 105.7(±56.6), 16 – 203ms; 50% of pts were admitted with a different diagnosis. PA was primary in 13(65%). Days of evolution at diagnosis: 11.1(±9.1) ds. Predisposing factors were found in 16(80%): trauma, skin and soft tissue infect and myelomeningocele

    Although it is unspecific, the triad of fever, lumbar/abdominal pain and limp was observed in 12(60%) pts, however 2 of them alone or in combination with other feature were present in additional 5(25%) pts. Abnormal acute phase reactants: Leucocyte: 19,005(±8,288)/mm3; ESR: 73.4(±30.2) mm/hr and CRP: 161.6 mg/dl(±92.5) were seen in most pts

    S.aureus was identified in 15(75%) cases; MRSA 12(80%); no other agent was identified. Only 3 pts had positive blood cultures. Diagnosis was confirmed by ultrasound: 13(65%), TC scan: 5(25%), MRI: 2(10%)

    Initial empirical therapy for S.aureus was applied in 100% pts on admission, CLI: 12(60%), CLI + VAN: 3(15%), other combinations: 5(25%). Duration of IV therapy: 18.4 (±14) ds. Pts who required drainage were diagnosed latter than those who weren´t drained(p 0.03), median 11 vs 7, respectively. Drainage was performed in 13(65%), although it was not associated to shorter hospital stay

    Complications: pneumonia, endocarditis and septic hip arthritis in 2 pts; in both of them the hospitalization was statistically longer: 49.5 (±40.3) vs 17.7 (±6.4), (p <0.001)

    Conclusion:

    ● Number of PA in children described in this report is higher than the literature reports

    ● PA should be suspected in pts with fever, lumbar/abdominal pain and limp

    ● Suspected PA should be explored by ultrasound at least at admission

    ● Pts who required drainage were diagnosed later in the evolution

    ● Complications of PA statistically prolongs the hospital stay

    Marina Elisa Pasinovich, MD, María Laura Praino, MD, Ximena S Juárez, MD, Micaela Delgado, MD, Claudia I. Cazes, MD and Eduardo López, MD, Hospital de Niños Dr. Ricardo Gutiérez, Ciudad Autónoma de Buenos Aires, Argentina

    Disclosures:

    M. E. Pasinovich, None

    M. L. Praino, None

    X. S. Juárez, None

    M. Delgado, None

    C. I. Cazes, None

    E. López, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.