{"id":1758,"date":"2003-10-01T01:00:00","date_gmt":"2003-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/traitement-des-abces-hepatiques-a-pyogenes-par-antibiotherapie-sans-drainage-resultats-sur-une-serie-de-31-malades\/"},"modified":"2018-10-20T18:39:30","modified_gmt":"2018-10-20T16:39:30","slug":"traitement-des-abces-hepatiques-a-pyogenes-par-antibiotherapie-sans-drainage-resultats-sur-une-serie-de-31-malades","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/traitement-des-abces-hepatiques-a-pyogenes-par-antibiotherapie-sans-drainage-resultats-sur-une-serie-de-31-malades\/","title":{"rendered":"TRAITEMENT DES ABCES HEPATIQUES A PYOGENES PAR ANTIBIOTHERAPIE SANS DRAINAGE : RESULTATS SUR UNE SERIE DE 31 MALADES"},"content":{"rendered":"

2003<\/strong><\/p>\n

H. HAG\u00e8GE, S. CAQUELIN, I. ROSA, P. CATTAN, S. RATEL-SABY, T. LONS, M. CHOUSTERMAN
\nService d\u2019H\u00e9pato-gastroent\u00e9rologie- CHI de Cr\u00e9teil- 40, avenue de Verdun 94010 Cr\u00e9teil Cedex<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02000-03-09 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Une antibioth\u00e9rapie est syst\u00e9matiquement associ\u00e9e au drainage percutan\u00e9 ou chirurgical pour le traitement des abc\u00e8s h\u00e9patiques \u00e0 pyog\u00e8nes (AHP). Des \u00e9volutions favorables sous antibioth\u00e9rapie sans drainage ont \u00e9t\u00e9 rapport\u00e9es, mais l\u2019efficacit\u00e9 de cette strat\u00e9gie th\u00e9rapeutique reste controvers\u00e9e. Le but de ce travail a \u00e9t\u00e9 d\u2019\u00e9valuer l\u2019efficacit\u00e9 du traitement des AHP par antibiotiques, sans drainage en premi\u00e8re intention, sur une large s\u00e9rie de malades.
\nMalades et m\u00e9thodes : Trente et un malades cons\u00e9cutifs (11 femmes et 20 hommes) d\u2019\u00e2ge moyen 65 ans (22 \u00e0 84 ans) hospitalis\u00e9s pour un ou plusieurs AHP ont \u00e9t\u00e9 trait\u00e9s en premi\u00e8re intention par antibioth\u00e9rapie sans drainage. Un drainage n\u2019\u00e9tait effectu\u00e9 qu\u2019en l\u2019absence de r\u00e9ponse au traitement antibiotique. Le diagnostic d\u2019AHP a \u00e9t\u00e9 port\u00e9 sur les anomalies cliniques et radiologiques, la mise en \u00e9vidence \u00e9ventuelle d\u2019un germe, la n\u00e9gativit\u00e9 de la s\u00e9rologie d\u2019amibiase et l\u2019\u00e9volution sous traitement. Il s\u2019agissait d\u2019un abc\u00e8s unique dans 24 cas (77 %) dont le diam\u00e8tre moyen \u00e9tait de 80 mm (50 \u00e0 140 mm). Dans les 7 autres cas (23 %), les abc\u00e8s \u00e9taient multiples. Un germe a \u00e9t\u00e9 isol\u00e9 dans 20 cas (65%): par ponction d\u2019abc\u00e8s dans 13 cas, par h\u00e9mocultures dans 12 cas et par les 2 dans 6 cas. Il s\u2019agissait d\u2019une infection pluri-microbienne dans 4 cas. La porte d\u2019entr\u00e9e des AHP a \u00e9t\u00e9 mise en \u00e9vidence dans 19 cas (61%). Il s\u2019agissait dans 6 cas d\u2019un abc\u00e8s dentaire, dans 6 cas d\u2019une pathologie biliaire, dans 5 cas d\u2019une sigmo\u00efdite diverticulaire, dans 1 cas d\u2019une py\u00e9lon\u00e9phrite et dans 1 cas d\u2019une infection pulmonaire.
\nR\u00e9sultats : L\u2019antibioth\u00e9rapie \u00e9tait adapt\u00e9e au(x) germe(s) isol\u00e9(s) ou \u00e0 d\u00e9faut avait un large spectre couvrant les ana\u00e9robies et les ent\u00e9robact\u00e9ries. La dur\u00e9e moyenne de traitement antibiotique a \u00e9t\u00e9 de 40 jours (23 \u00e0 76 jours). L\u2019\u00e9volution sous antibioth\u00e9rapie sans drainage a \u00e9t\u00e9 favorable dans 27 cas (87 %) sans qu\u2019aucune r\u00e9cidive n\u2019ait \u00e9t\u00e9 observ\u00e9e durant le suivi. Chez 4 malades, la persistance de la fi\u00e8vre et \u00e9galement de douleurs pour 2 d\u2019entre-eux a n\u00e9cessit\u00e9 un drainage. Ce drainage a \u00e9t\u00e9 r\u00e9alis\u00e9 par voie chirurgicale dans 3 cas et par voie percutan\u00e9e sous \u00e9chographie dans 1 cas. Deux complications du traitement ont \u00e9t\u00e9 observ\u00e9es : une mycose buccale et une allergie cutan\u00e9e aux antibiotiques. L\u2019\u00e9volution a \u00e9t\u00e9 constamment favorable avec une mortalit\u00e9 nulle dans cette s\u00e9rie.
\nConclusions : Dans notre exp\u00e9rience et sur une large s\u00e9rie de malades, le traitement des AHP par antibioth\u00e9rapie exclusive, sans drainage en premi\u00e8re intention, est efficace dans 87 % des cas. Cette attitude th\u00e9rapeutique n\u2019a pas entra\u00een\u00e9 de complications s\u00e9v\u00e8res et la mortalit\u00e9 a \u00e9t\u00e9 nulle. Le drainage percutan\u00e9 ou chirurgical nous para\u00eet ne devoir \u00eatre recommand\u00e9 que pour les formes r\u00e9sistantes au traitement antibiotique.<\/p>\n","protected":false},"excerpt":{"rendered":"

2003 H. HAG\u00e8GE, S. CAQUELIN, I. ROSA, P. CATTAN, S. RATEL-SABY, T. LONS, M. CHOUSTERMAN Service d\u2019H\u00e9pato-gastroent\u00e9rologie- CHI de Cr\u00e9teil- 40, avenue de Verdun 94010 Cr\u00e9teil Cedex H\u00e9patologie – \u00a02000-03-09 –\u00a0CO – ________________________________ Une antibioth\u00e9rapie est syst\u00e9matiquement associ\u00e9e au drainage percutan\u00e9 ou chirurgical pour le traitement des abc\u00e8s h\u00e9patiques \u00e0 pyog\u00e8nes (AHP). Des \u00e9volutions favorables […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[14],"class_list":["post-1758","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-14"],"yoast_head":"\nTRAITEMENT DES ABCES HEPATIQUES A PYOGENES PAR ANTIBIOTHERAPIE SANS DRAINAGE : RESULTATS SUR UNE SERIE DE 31 MALADES - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/traitement-des-abces-hepatiques-a-pyogenes-par-antibiotherapie-sans-drainage-resultats-sur-une-serie-de-31-malades\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"TRAITEMENT DES ABCES HEPATIQUES A PYOGENES PAR ANTIBIOTHERAPIE SANS DRAINAGE : RESULTATS SUR UNE SERIE DE 31 MALADES - 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