Abstract
Background
The causes and management of pyogenic liver abscess (PLA) have undergone multiple changes over the past decades. It is a relatively rare disease in the USA, and its incidence rate in the USA is increasing. The last US community hospital experience of PLA was published in 2005. We performed a retrospective study of patients admitted with PLA to an urban safety net hospital.
Aims
To ascertain risk factors, management approaches, and outcomes of PLA.
Methods
Electronic medical record was queried for diagnosis codes related to PLA during the years 2009–2018. Clinical information was compiled in an electronic database which was later analyzed. Main study outcomes were in-hospital mortality, 30-day readmission rate, and intensive care utilization rate.
Results
A total of 77 patients with PLA were admitted in the study period. Most common risk factors were diabetes mellitus (23.4%), previous liver surgery (20.7%), and hepatic malignancy (16.9%). 89% of patients were treated with percutaneous drainage or aspiration, and surgical drainage was reserved for other with other indications for laparotomy. In-hospital mortality, 30-day readmission, and intensive care utilization rates were 2.6%, 7% and 22%, respectively. Median length of stay was 11 days (inter-quartile range 7). Rate of antimicrobial resistance in abscess fluid cultures was 40%; 13 cases of Klebsiella pneumoniae liver abscess were noted in our cohort, most of whom were Hispanic or Asian.
Conclusions
PLA was principally managed by percutaneous drainage or aspiration with good outcomes. Further studies investigating the racial predilection of K. pneumoniae liver abscesses could reveal clues to its pathogenesis.
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References
Altemeier WA, Culbertson WR, Fullen WD, Shook CD. Intra-abdominal abscesses. Am J Surg. 1973;125:70–79.
Krige JE, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system. BMJ (Clinical Research ed). 2001;322:537–540.
Meddings L, Myers RP, Hubbard J, et al. A population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol. 2010;105:117–124. https://doi.org/10.1038/ajg.2009.614.
Sharma A, Mukewar S, Mara KC, Dierkhising RA, Kamath PS, Cummins N. Epidemiologic factors, clinical presentation, causes, and outcomes of liver abscess: a 35-year Olmsted county study. Mayo Clin Proc Innov Qual Outcomes. 2018;2:16–25. https://doi.org/10.1016/j.mayocpiqo.2018.01.002.
Chen YC, Lin CH, Chang SN, Shi ZY. Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000–2011. J Microbiol Immunol Infect. 2016;49:646–653. https://doi.org/10.1016/j.jmii.2014.08.028.
Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg. 1996;223:600–607. (discussion 7–9).
Mavilia MG, Molina M, Wu GY. The evolving nature of hepatic abscess: a review. J Clin Transl Hepatol. 2016;4:158–168. https://doi.org/10.14218/JCTH.2016.00004.
Gallagher MC, Andrews MM. Postdischarge outcomes of pyogenic liver abscesses: single-center experience 2007–2012. Open Forum Infect Dis. 2017;4:ofx159. https://doi.org/10.1093/ofid/ofx159.
Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39:1654–1659. https://doi.org/10.1086/425616.
Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29:996–1011. https://doi.org/10.1086/591861.
Cerwenka H. Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol. 2010;16:2458–2462.
Longworth S, Han J. Pyogenic liver abscess. Clin Liver Dis (Hoboken). 2015;6:51–54. https://doi.org/10.1002/cld.487.
Ali AH, Smalligan RD, Ahmed M, Khasawneh FA. Pyogenic liver abscess and the emergence of Klebsiella as an etiology: a retrospective study. Int J Gen Med. 2013;7:37–42. https://doi.org/10.2147/IJGM.S54448.
Jepsen P, Vilstrup H, Schønheyder HC, Sørensen HT. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977–2002. Aliment Pharmacol Ther. 2005;21:1185–1188. https://doi.org/10.1111/j.1365-2036.2005.02487.x.
Mc FA, Chang KP, Wong CC. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics; a report of 14 consecutive cases with recovery. Br J Surg. 1953;41:141–152. https://doi.org/10.1002/bjs.18004116606.
Hope WW, Vrochides DV, Newcomb WL, Mayo-Smith WW, Iannitti DA. Optimal treatment of hepatic abscess. Am Surg. 2008;74:178–182.
Chemaly RF, Hall GS, Keys TF, Procop GW. Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures. Diagn Microbiol Infect Dis. 2003;46:245–248.
Tsai F-C, Huang Y-T, Chang L-Y, Wang J-T. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis. 2008;14:1592–1600. https://doi.org/10.3201/eid1410.071254.
Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12:881–887. https://doi.org/10.1016/s1473-3099(12)70205-0.
Yu WL, Ko WC, Cheng KC, et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 2006;42:1351–1358. https://doi.org/10.1086/503420.
Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007;45:284–293. https://doi.org/10.1086/519262.
Lee HC, Chuang YC, Yu WL, et al. Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: association with invasive syndrome in patients with community-acquired bacteraemia. J Intern Med. 2006;259:606–614. https://doi.org/10.1111/j.1365-2796.2006.01641.x.
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Mukthinuthalapati, V.V.P.K., Attar, B.M., Parra-Rodriguez, L. et al. Risk Factors, Management, and Outcomes of Pyogenic Liver Abscess in a US Safety Net Hospital. Dig Dis Sci 65, 1529–1538 (2020). https://doi.org/10.1007/s10620-019-05851-9
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DOI: https://doi.org/10.1007/s10620-019-05851-9