Treatment Of Complicated Intra-abdominal Infections With CT-guided Percutaneous Drainage: An Retrospective Analysis Of 86 Cases

Objectives To summary the experience of treatment of complicated intra-abdominal infections by CT-guided percutaneous drainage and evaluate its efficacy.Methods From November 2003 to September 2009, CT-guided percutaneous drainage were performed in 86 patients with complicated intra-abdominal infections in the affiliated Sir Run Run Shaw Hospital of Zhejiang University. Clinical data of 86 cases, including gender, age, infection source, body temperature, white blood cell, neutral granule cells, bacterial culture and susceptibility test of drain fluid etc, were retrospectively analyzed. Body temperature, white blood cell and neutrophil count before and after drainage were recorded and compared particularly.Results (1) A total of 86 patients (45 men and 41 women; median age of 58 years, mean (56.31±10.52) years, range from 17 to 93 years) with complicated intra-abdominal infections underwent CT-guided percutaneous drainage. Complicated intra-abdominal infections were caused by abdominal operation in 78 cases (91%). The infections in the rest 8 cases (9%) were caused by other sources.(2) Seventy-seven cases(90%) had single lesion of intra-abdominal infection, among them:fifty-nine cases were cured with single puncture and drainage,15 cases were cured with more than one times of puncture and drainage, three cases underwent laparotomy after CT-guided puncture and drainage (one patient had disruption of wound postoperatively, two patients had infection deteriorated). Nine cases(10%) had more than one infection lesions, among them:eight cases were cured with single punture and drainage, one case was cured with three times of punture and drainage.(3) During 0-24h before drainage, Seven patients (8%) had their body temperatures between 36.5℃and 37.2℃(group A), sixteen patients(19%) had their body temperatures between 37.3℃and 38.0℃(group B), thirty-nine patients(45%) had their body temperatures between 38.1℃and 39.0℃(group C), twenty-four patients(28%) had their body temperatures between 39.1℃and 41.0℃(group D). In group A, patients'temperatures measured at 0-24h,24-48h,48-72h after drainage had no significant difference from their temperature 0-24h before drainage(P> 0.05); In group B, C, and D, patients'temperatures dropped down significantly after CT guided drainage(P< 0.05). Among group B, C and D:fifty-two patients'temperature(65.82%) had dropped down to normal (36.5-37.2℃) in 72 hours.(4)Complete blood counts were performed in 57 cases before and after drainage. Among them:white blood cell (WBC) counts were normal (4-10×103/ul) in 15 cases (26%) at 0-24h before drainage(groupⅠ); WBC counts were above normal (> 10×103/ul) in 42 cases (74%) at 0-24h before drainage(groupⅡ). Compared with the WBC counts at 0-24h before drainage, the WBC counts of groupⅠand groupⅡat 0-24h,48-72h after drainage have significant dropped (P< 0.05).(5)Bacterial culture and susceptibility test were performed in all 86 patients:57 of 86 patients had positive culture results. Susceptibility test showed ESBL (Extended-Spectrumβ-lactamase) positive in 23 patients.(6)The average length of stay (LOS) of patients who had single intra-abdominal infection lesion was (20.88±14.31) days (range from 3 to 103 days); Drainage tubes were removed in 41 cases during their hospital stay period; Average drainage time was (19.27±11.30) days (range from 3 to 87 days), the rest 33cases removed drainage tube is in outpatient. The average length of stay of patients who had more than one intra-abdominal infection lesions were (30.11±17.70) days (range from 8 to 85days);...