Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

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Abstract
The usual treatment of bacterial abscesses, except lung or tubo-ovarian abscesses, includes therapeutic drainage. Increasing evidence suggests that some abscesses respond to antimicrobial therapy without drainage. To study this issue, a MEDLINE search of the literature (1966–1994) was performed for cases of bacterial abscess in which treatment without definitive drainage was attempted. Four hundred sixty-five cases were identified. The most commonly involved organs were the liver, brain, and kidney. The success rate of antimicrobial therapy was 85.9%. Factors that predicted a less favorable outcome were abscess diameter of ⩾ 5 cm (odds ratio [OR] = 37.7; P = .0003), involvement of ⩾ 1 organism (OR = 5.2; P = .014), presence of gram-negative bacilli (OR = 3.4; P = .022), length of therapy of P < .0001), and use of an aminoglycoside as the only active agent (OR = 11.8; P = .008). Many bacterial abscesses can be treated without drainage; abscess size, the organisms involved, and therapy utilized may influence outcome.

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