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Pyogenic Liver Abscess: Does Escherichia Coli Cause more Adverse Outcomes than Klebsiella Pneumoniae?

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Abstract

Background

This paper aims to demonstrate if Escherichia coli pyogenic liver abscess (ECPLA) results in adverse outcomes compared to Klebsiella pneumoniae PLA (KPPLA).

Methods

A retrospective review of all patients admitted at a tertiary hospital in Singapore from 2003 to 2011 was performed. Patients with age <18 years, amoebic liver abscess, infected liver cyst, culture negative abscess or ruptured liver abscess requiring urgent surgical intervention were excluded. Only patients with blood or pus culture confirmation of ECPLA (n = 24) or KPPLA (n = 264) were included. Median length of hospital stay, failure of non-operative therapy and 30-day mortality are the reported outcomes.

Results

ECPLA affects older patients (68 vs. 62 years, p = 0.049). Ischemic heart disease was more common in ECPLA (29 vs. 14 %, p = 0.048) and there was no difference in diabetic state (42 vs. 38 %, p = 0.743). ECPLA is more commonly associated with hyperbilirubinemia (60 vs. 34 µmol/L, p = 0.003), increased gamma-glutamyl transpeptidase (236 vs. 16 IU/L, p = 0.038) and gallstones (58 vs. 30 %, p = 0.004). KPPLA are larger in size (6 vs. 4 cm, p = 0.006) and had percutaneous drainage (PD) more frequently (64 vs. 42 %, p = 0.034). There was no difference in median hospital stay (14 vs. 14 days, p = 0.110) or 30-day mortality (17 vs. 10 %, p = 0.307) between ECPLA and KPPLA. Among patients with ECPLA, antibiotic treatment with PD appeared to have higher mortality compared to antibiotic treatment alone (30 vs. 7 %) but this was not significant (p = 0.272).

Conclusion

In the setting of multimodal care, outcomes of ECPLA are comparable to KPPLA.

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Conflict of interest

The authors do not report any conflicts of interest.

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Author notes

    Authors and Affiliations

    1. Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore

      Vishal G. Shelat, Clement L. K. Chia, Winston Woon & Sameer P. Junnarkar

    2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore

      Charleen S. W. Yeo

    3. Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253, Singapore

      Clement L. K. Chia & Wang Qiao

    Authors
    1. Vishal G. Shelat
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    Correspondence to Vishal G. Shelat.

    Additional information

    Dr Vishal G Shelat and Dr Clement LK Chia contributed equally to the work.

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    Shelat, V.G., Chia, C.L.K., Yeo, C.S.W. et al. Pyogenic Liver Abscess: Does Escherichia Coli Cause more Adverse Outcomes than Klebsiella Pneumoniae?. World J Surg 39, 2535–2542 (2015). https://doi.org/10.1007/s00268-015-3126-1

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    • DOI: https://doi.org/10.1007/s00268-015-3126-1

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