HomeAnswersFamily Physiciane.coli infectionWhat is the indication of TB test for abscess drainage?

Culture and sensitivity test of abscess drainage shows E.coli. Is it required to conduct TB test?

Share

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At July 11, 2020
Reviewed AtJuly 4, 2023

Patient's Query

Hello doctor,

My samples were taken for culture and sensitivity tests and a TB test during the abscess drainage. However, the TB tests could not be successfully conducted due to certain medical reasons. The culture and sensitivity test showed the presence of E.coli bacteria. I was prescribed antibiotics that are sensitive to E.coli for a duration of five days following the surgery. I was prescribed Amoxicillin with Clavulanic acid, Cefuroxime, Linezolid, and Clarithromycin. Is it necessary to conduct additional tests for TB? Also, will the CT scan be performed with contrast? This concern arises from my previous experience after the last CT scan with contrast, which resulted in high fever, chills, and vomiting. Kindly provide your opinion.

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. Based on the information you provided, It seems that there have been no culture and sensitivity tests conducted on the fluid before administering antibiotics, which may explain why the infection has recurred. Additionally, it is necessary to remove the formed sinus and administer long-term antibiotics. Fortunately, it appears that the infection has not spread to the peritoneum, which could have resulted in various complications. However, since three months have passed since the last CT (computed tomography) scan, I suggest you undergo another CT scan of the abdomen to assess the current status. Two positive aspects are that there seems to be improvement in the condition, and there is no involvement of the peritoneum, suggesting that more intensive therapies could lead to recovery. The next CT scan does not need to involve contrast, but rather a plain, high-resolution, 64-slice (possibly) CT scan of the abdomen and pelvis. I suggest you undergo a chest CT image also to rule out other potential causes as well. Additionally, the drainage fluid after surgery should undergo antibiotic susceptibility tests to determine the most appropriate antibiotics and their combinations for this instance. I suggest you consult a gastrointestinal surgeon for further management. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

The Probable causes

The probable diagnosis is reinfection, improperly treated previous infection or multiresistant bacterial infection.

Investigations to be done

1. CT scan of abdomen and pelvis (16 slices). 2. Antibiotic culture and sensitivity of the fluid accumulation.

Differential diagnosis

Local tumor.

Probable diagnosis

Reinfected sinus tract.

Treatment plan

1. CT scan. 2. Drainage of the fluid for antibiotic susceptibility and resistance tests. 3. Intravenous antibiotics after getting the culture sensitivity fluid report and selecting the right antibiotic. Imipenem, Vancomycin, or Tedizolid are likely candidates. 4. Long-term (4-6 weeks) post-discharge antibiotic coverage.

Regarding follow up

Kindly follow-up with suggested CT scan reports.

Patient's Query

Thank you doctor for the reply,

Is it necessary to undergo a test for abdominal tuberculosis?

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. It does not appear to be necessary since E. Coli has already been diagnosed. However, as a precautionary measure, you can undergo the abdominal TB test. Based on the information you provided, you do not exhibit symptoms of TB. Alternatively, you may consider undergoing a blood test called TB Gold (RT PCR). I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor for the prompt reply,

I will follow up with the reports as you have suggested. However, I would like to inquire why is my chest CT scan required?

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.I would like to inform you that a chest CT scan is necessary to facilitate the differential diagnosis of noninfective causes and to assess for any potential spread to the pleural or lung areas. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thank you doctor for the reply,

Today, I visited a general surgeon who recommended drainage under anesthesia. However, he did not suggest any additional tests. My concern is whether drainage is the only solution, considering that it was already performed three months ago and reinfection has now occurred.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I would like to inform you that drainage is an appropriate approach as long as the perioperative and postoperative antibiotic regimen is evidence-based. This means that the antibiotic therapy should be determined based on antimicrobial susceptibility and resistance testing of the drainage fluid. I suggest you consult a gastrointestinal surgeon to rule out any potential peritoneal spread during and after the surgery. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

Thank you for the prompt reply,

I underwent an MRI and pus culture few month back. After reviewing the reports, the surgeon planned the surgery a few months ago and left the wound open for healing by secondary intention. I was prescribed antibiotics based on the culture sensitivity report for a duration of two months. Regular dressing changes have been conducted, but after three months, it was observed that the left portion of the surgical wound ceased to heal and a small tract formed with light discharge. The area also became tender. A local incision was performed to open and remove the tract. During the procedure under local anesthesia, two small pieces of suture material were discovered in the area, along with some fibrous tissue. The discharge is still ongoing but in small amounts. A pus sample was collected for a culture and sensitivity report, and the results received yesterday revealed the presence of MRSA. Kindly help.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I suggest you undergo antibiotic culture and sensitivity tests, and receive the perioperative and postoperative antibiotic therapy accordingly. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shubadeep Debabrata Sinha
Dr. Shubadeep Debabrata Sinha

Infectious Diseases

Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Ask your health query to a doctor online

Family Physician

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy