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Perinephric Abscess — SCE Infectious Diseases MCQ

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ModerateHealthcare-Associated InfectionsPerinephric AbscessSCE Infectious Diseases

A 60-year-old man with a history of recurrent UTIs develops a perinephric abscess. CT shows a 5 cm rim-enhancing collection around the right kidney. Urine culture grows E. coli. He is haemodynamically stable. What management is required?

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Correct answer: D — Percutaneous drainage plus IV antibiotics (typically 2–4 weeks)

Perinephric abscess >3 cm requires percutaneous drainage (or surgical drainage if percutaneous is not feasible) plus prolonged IV antibiotics. Antibiotics alone have high failure rates for established abscesses. E. coli is the most common causative organism, arising from ascending UTI with pyelonephritis and subsequent perinephric extension. Diabetes mellitus, urinary obstruction, and renal calculi are predisposing factors. Total antibiotic duration is typically 2–4 weeks (IV then oral step-down).

Reference: NICE NG109 2018 – UTI complications; EAU 2024 – Urological infections