SP4.11 Psoas abscess management: A Multimodal Approach to Treatment Modalities, Predictors of clinical outcomes and a Novel Treatment Algorithm

Background/Aim Psoas muscle abscess is a rare and challenging condition to diagnose and manage. The absence of a robust, evidence-based treatment algorithm has led to inconsistencies in clinical practice. This study comprehensively analysed PMA management across three treatment modalities: conservative management, image-guided interventional radiology (IR) drainage, and open surgery. Aim is to analyse the management of psoas muscle abscess (PMA) across treatment modalities and identify predictors of poor outcomes. We also propose a new treatment algorithm to standardize and improve care. Methods A retrospective analysis was conducted on 100 adult cases treated at our hospital over the past 10 years. Data collected included demographics, clinical and laboratory parameters, imaging findings, microbiology results, and clinical outcomes. Results Conservative management exhibited the highest recurrence rate (58.9%), compared to the IR group (37.3%, p = 0.006) and the open surgery group (30.0%, p = 0.033). Novel to this study, negative cultures were significantly associated with worse outcomes, including higher recurrence (p < 0.01) and mortality (p = 0.01) rates. Staphylococcus aureus was the most isolated pathogen and was linked to increased mortality (p = 0.01). Immune suppression (p = 0.03) and CKD ≥3 (p = 0.01) was also identified as critical predictors of recurrence, mortality and poor outcome. Conclusion This study underscores the importance of early and aggressive intervention in PMA management, particularly in high-risk patients with large abscesses, negative cultures, immune suppression, or CKD ≥3. A clinical algorithm was developed to guide treatment decisions, aiming to reduce recurrence and improve survival outcomes