Outcome of percutaneous drainage for septic complications coexisted with COVID-19

Mohamed A Deif; Ahmad M Mounir; Sherif A Abo-Hedibah; Ahmed M Abdel Khalek; Ali H Elmokadem

doi:10.4329/wjr.v14.i4.91

Outcome of percutaneous drainage for septic complications coexisted with COVID-19

World J Radiol. 2022 Apr 28;14(4):91-103. doi: 10.4329/wjr.v14.i4.91.

Authors

Mohamed A Deif¹, Ahmad M Mounir², Sherif A Abo-Hedibah³, Ahmed M Abdel Khalek², Ali H Elmokadem⁴

Affiliations

¹ Department of Radiology, National Liver Institute, Menoufia University, Shibin Al Kawm 32521, Egypt.
² Department of Radiology, Mansoura University, Mansoura 35516, Egypt.
³ Department of Radiology, Cairo university, Cairo 12613, Egypt.
⁴ Department of Radiology, Mansoura University, Mansoura 35516, Egypt. mokadem83@yahoo.com.

Abstract

Background: The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019 (COVID-19) combined with viral load, and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.

Aim: To describe the clinical, radiological, and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their post-procedural outcomes.

Methods: This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications. The mean age ± SD of the patients was 48.5 ± 14 years (range 30-72 years). Three patients underwent cholecystostomy for acute acalculous cholecystitis. Percutaneous drainage was performed in seven patients; two peripancreatic collections; two infected leaks after hepatic resection; one recurrent hepatic abscess, one psoas abscess and one lumbar abscess. One patient underwent a percutaneous nephrostomy for acute pyelonephritis.

Results: Technical success was achieved in 100% of patients, while clinical success was achieved in 4 out of 11 patients (36.3%). Six patients (54.5%) died despite proper percutaneous drainage and adequate antibiotic coverage. One patient (9%) needed operative intervention. Two patients (18.2%) had two drainage procedures to drain multiple fluid collections. Two patients (18.2%) had repeat drainage procedures due to recurrent fluid collections. The average volume of the drained fluid immediately after tube insertion was 85 mL. Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients. There was no significant statistical difference (P = 0.6 and 0.4) between the mean of WBCs and neutrophils count before drainage and seven days after drainage. The lymphocyte count shows significant increased seven days after drainage (P = 0.03).

Conclusion: In this study, patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.

Keywords: Abscess; COVID-19; Coronavirus; Drainage; SARS-CoV-2; Sepsis.