Presented by: Kapilan Ravichandran
Toowoomba Hospital

Introduction

To establish the demographic, clinical, radiological and laboratory profiles of renal abscess and perinephric abscess with related treatment and outcomes at a tertiary tropical Australian Hospital. Risk factors for development of large abscesses (greater than 3cm) were identified as well as an analysis of the experience of Indigenous patients.

Materials

A thorough retrospective analysis was carried out on the medical records of all patients diagnosed with renal and perinephric abscesses between January 2013 and January 2023. The collected data were subjected to comprehensive statistical analysis, primarily utilizing descriptive statistics. To determine the risk factors associated with the development of large abscesses, univariate logistic regression analysis was employed. Variables showing significant associations in the univariate analysis were then included in a multivariate logistic regression model to identify independent risk factors. Furthermore, a sub-group analysis was conducted to investigate the unique characteristics and outcomes among the Indigenous Population.

Results

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The identified patient cohort consisted of 63 individuals, with renal abscesses observed in 31 cases, perinephric abscesses in 20 cases, and combined abscesses in 11 cases. Flank pain and fevers were the most common presenting symptoms, reported in 80% and 70% of the patients, respectively. Diabetes mellitus emerged as the primary predisposing condition, noted in 60% of the cases. Escherichia coli was the predominant microorganism isolated from pus cultures, accounting for 68% of the cases, with 30% of these strains being extended-spectrum beta-lactamase (ESBL) producing. The main treatment approach involved intravenous (IV) antibiotics alone in 51% of the patients, while IV antibiotics with aspiration and IV antibiotics with drainage were employed in 6% and 43% of the cases, respectively. Regrettably, one death occurred during the study period. Our analysis also revealed that advanced age (>60 years) and a symptom duration exceeding 7 days prior to presentation were identified as significant risk factors for the development of large abscesses. Furthermore, subgroup analysis focusing on the indigenous population revealed that they presented at a younger age (mean age 39.5 years) compared to non-indigenous individuals (mean age 47.5 years) and experienced a longer duration of symptoms prior to seeking medical attention (mean of 8 days). Indigenous patients also had a lengthier hospital stay (mean of 7.1 days) compared to non-indigenous patients (mean of 5.1 days). 

Conclusion

Study highlights the common clinical features, prevalent organism and associated co-morbidities with renal and perinephric abscesses in a Tertiary centre in Australia. Furthermore the study suggest that there is a need for increased awareness and education of the signs and symptoms especially in the indigenous population.These findings highlight the importance of tailored management strategies and further research to address the unique characteristics and needs of different patient populations in the context of renal and perinephric abscesses in Tropical Queensland.

Funding

Ni 

Lead Authors

William Harrison,
Toowoomba Hospital