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[Recent changes of organism and treatment in pyogenic liver abscess]
Byung Kyu Nah1, Yeon Soo Kim, Hee Seok Moon
1Department of Internal medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Background/Aims:
With the advance of antibiotics and the development of newer imaging techniques, marked changes in etiology, diagnosis, treatment and prognosis of liver abscess have been reported.
Methods:
We reviewed the clinical data related to 94 patients with pyogenic liver abscess.
Results:
Of the 94 patients in the study group, the male to female ratio was 1.4:1 and the peak incidence of liver abscess was in the 7th decade. About three quarters (74.5%) of the abscesses were of unknown origin. The predominant location was in the right lobe (70.3%). Single lesion was found in 80 patients and multiple lesions in 14 patients. Pathogens were identified in 67 patients, of which Klebsiella pneumoniae (65.7%) and E. coli (16.4%) were the most common. The modalities of treatment were percutaneous drainage with antibiotics (73.4%), percutaneous aspiration with antibiotics (16.0%), or antibiotics alone (8.5%). The case fatality rate, mainly from associated underlying diseases, was 9 cases (9.6%). Associated diseases were diabetes mellitus (14.9%) and malignancy (10.6%).
Conclusions:
Our study revealed that the most common organism was Klebsiella pneumoniae and percutaneous needle aspiration and/or catheter drainage were safe and effective treatment modalities for pyogenic liver abscess. Prognosis was determined by the underlying condition.
Insights
Pyogenic liver abscess is often caused by Klebsiella pneumoniae. Percutaneous drainage or aspiration with antibiotics are safe and effective treatments for liver abscess.
Area of Science:
- Hepatology
- Infectious Diseases
- Medical Microbiology
Context:
- Pyogenic liver abscess (PLA) management has evolved with advances in antibiotics and imaging.
- Understanding current trends in PLA etiology, diagnosis, and treatment is crucial.
Purpose:
- To review the clinical characteristics, causative pathogens, treatment strategies, and outcomes of pyogenic liver abscess.
- To evaluate the efficacy and safety of percutaneous drainage and aspiration in PLA management.
Summary:
- This study analyzed 94 patients with PLA, identifying Klebsiella pneumoniae as the most common pathogen.
- Percutaneous needle aspiration and/or catheter drainage combined with antibiotics were found to be safe and effective treatments.
- The case fatality rate was 9.6%, primarily linked to underlying conditions like diabetes mellitus and malignancy.
Impact:
- Highlights Klebsiella pneumoniae as a leading cause of PLA, guiding empirical antibiotic choices.
- Establishes percutaneous interventions as preferred, safe, and effective treatment modalities for PLA.
- Emphasizes the critical role of managing underlying comorbidities in improving PLA patient prognosis.
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