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Background Psoas abscess (PA) is an uncommon disease that has been increasingly reported in the recent years. We reviewed patients with PA and analyzed their clinical characteristics to improve our understanding of this rare disorder. Methods We retrospectively reviewed the clinical presentations, microbiology, and outcomes of patients with PA between 2011 and 2022 at the Zhejiang Provincial People's Hospital in China. Results There were 40 adult patients identified with the discharge diagnosis of PA. The mean age was 60 years, and 67.5% of the patients were male. Primary symptoms were typically nonspecific. In all, 20 abscesses were considered secondary, and the most common was infective spondylitis. The most common causative organism for primary PA was Staphylococcus aureus , followed by Escherichia coli , whereas multiple bacterial species were found in secondary abscesses. The overall in-hospital mortality rate was 5%. Patients with secondary PA had a longer hospital stay. Conclusion PA, as a serious infectious condition, usually presents with nonspecific symptoms and laboratory test results, making early diagnosis difficult. These profiles differed from those reported in the present study. The initial clinical status and subsequent imaging studies can lead to favorable outcomes. What is already known on this topic Psoas abscess (PA) is an uncommon disease with nonspecific symptoms and laboratory test results that few studies were seen. What this study adds Patients with psoas abscess showed clinical characteristics different from previous reports. The causative organism was found to be multiple. How this study might affect research, practice, or policy We suggest that a thorough medical history and subsequent imaging studies can be useful for the diagnosis and treatment. [ABSTRACT FROM AUTHOR]