Antibiotic Effectiveness in Persistent Fever and Abscess Cases

The effects of antibiotics?

Hello Doctor: A child has been experiencing unexplained persistent fever.
During this time, the physician prescribed oral antibiotics.
After two weeks of continuous fever, the child was hospitalized for observation.
During the hospitalization, first-line antibiotic treatment continued.
On the third day of hospitalization, a pus-filled abscess was discovered at the site of a hernia surgery performed two years prior.
The abscess was surgically drained, and first-line antibiotics were continued.
A sample from the abscess was sent for bacterial culture, but no bacteria were found.
The attending physician explained that the use of antibiotics prior to surgery likely prevented bacterial survival.
However, one week after the first surgery, the fever did not improve.
The physician continued with first-line and second-line antibiotics and performed ultrasound and CT scans, which revealed a 4cm x 5cm x 6cm abscess between the peritoneum and the bladder.
A second surgery was conducted to remove the abscess, and another sample was taken for bacterial culture, but again, no bacteria were detected.
The physician reiterated that this was due to the effectiveness of the antibiotics.
Therefore, I would like to ask the doctor: if the antibiotics are indeed effective enough to prevent bacterial survival in the abscess, why did a second abscess occur? What is the likelihood of this happening? Thank you for your response.

Jar, 30~39 year old female. Ask Date: 2006/12/10

Dr. Lin Mingfeng reply Internal Medicine

During the surgical discovery, it was confirmed that there was pus.
In addition to the possibility that prior antibiotic use may have inhibited bacterial culture growth, one must also consider the presence of Mycobacterium, fungi, or other fastidious bacteria.
Therefore, the obtained specimens should be cultured for these organisms.
Additionally, a Gram stain can be performed on the specimens for preliminary assessment.
Furthermore, the patient's immune status and whether the debridement surgery was complete should also be taken into account.

Reply Date: 2006/12/10

More Info

In cases of persistent fever and abscess formation, the effectiveness of antibiotics can be a complex issue, particularly when the causative bacteria are not identified through culture. Your situation highlights several important aspects of antibiotic treatment, abscess management, and the potential for recurrent infections.

First, it is essential to understand that antibiotics are designed to target and eliminate bacterial infections. However, their effectiveness can be influenced by various factors, including the timing of administration, the type of bacteria involved, and the presence of any underlying conditions that may complicate the infection. In your case, the initial use of antibiotics prior to the surgical intervention may have suppressed bacterial growth to the point where cultures returned negative results, even though an infection was present.

When an abscess is formed, it is typically due to a localized collection of pus, which can be caused by bacteria. The presence of an abscess often indicates that the body is attempting to fight off an infection. If antibiotics are administered before the abscess is drained, they may reduce the bacterial load, but they do not necessarily eliminate the infection entirely. This can lead to a situation where the abscess remains, and the patient continues to experience symptoms such as fever.

The recurrence of an abscess, as seen in your case, can occur for several reasons:
1. Inadequate Drainage: If the initial surgical intervention did not fully drain the abscess or if there were multiple pockets of infection, the remaining infected tissue can lead to a new abscess formation.

2. Antibiotic Resistance: If the bacteria involved are resistant to the antibiotics used, they may survive treatment and lead to recurrent infections. This is particularly concerning in cases where broad-spectrum antibiotics are used without identifying the specific pathogen.

3. Underlying Conditions: Certain medical conditions, such as diabetes or immunosuppression, can predispose individuals to recurrent infections and abscess formation. It is crucial to evaluate any underlying health issues that may contribute to the persistence of infection.

4. Biofilm Formation: Some bacteria can form biofilms, which are protective layers that make them more resistant to antibiotics. This can lead to chronic infections that are difficult to treat.

In your situation, the fact that cultures returned negative after both surgical interventions raises questions about the appropriateness of the antibiotic therapy and the need for further investigation. It is essential to consider whether the antibiotics used were effective against the suspected pathogens and whether any other factors could be contributing to the persistent fever and abscess formation.

Given the complexity of your case, it would be advisable to consult with an infectious disease specialist. They can provide a more in-depth evaluation of the situation, including the possibility of conducting additional tests to identify any resistant organisms or underlying conditions that may be contributing to the recurrent abscesses.

In summary, while antibiotics can be effective in treating bacterial infections, their effectiveness can be compromised by several factors, leading to persistent symptoms and recurrent abscesses. Close monitoring, appropriate surgical intervention, and tailored antibiotic therapy are crucial in managing such cases effectively. If you continue to experience symptoms or have concerns about your treatment, do not hesitate to seek further medical advice.

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