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Bacterial liver abscess in children
Insights
This study found that percutaneous transhepatic drainage (PTHD) guided by ultrasonography is a safe and effective treatment for pediatric bacterial liver abscesses, with a low mortality rate.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Interventional Radiology
Background:
- Bacterial liver abscesses in children are a significant clinical challenge.
- Early diagnosis and effective management are crucial for favorable outcomes.
Purpose of the Study:
- To analyze the clinical characteristics, management, and outcomes of pediatric bacterial liver abscesses.
- To evaluate the safety and efficacy of percutaneous transhepatic drainage (PTHD) in treating these cases.
Main Methods:
- Retrospective review of 136 children diagnosed with bacterial liver abscess from November 1987.
- Diagnostic methods included radiography, ultrasonography, PTHD, and radioisotope scanning.
- Treatment strategies encompassed surgical drainage, PTHD, and antibiotic therapy.
Main Results:
- Staphylococcus aureus and Escherichia coli were the most common pathogens identified.
- Percutaneous transhepatic drainage (PTHD) was performed in 15 cases with successful survival.
- Antibiotic therapy alone resulted in a mortality rate of 1.47% and a response rate of 36.3%.
Conclusions:
- Percutaneous transhepatic drainage (PTHD) under ultrasonographic guidance is a safe and effective minimally invasive treatment for pediatric bacterial liver abscess.
- Prompt diagnosis and appropriate management, including drainage, are essential to reduce morbidity and mortality.
Abstract:
From November 1987, 136 children with bacterial liver abscess were encountered. There were 97 males and 39 females and the age ranged from 1-15 years (mean = 8.42 years). The clinical signs and symptoms of liver abscess were confirmed by radiography, ultrasonography, percutaneous transhepatic drainage (PTHD) and radioisotope scanning. 103 children had solitary abscess and the remaining 33 children, multiple abscesses. Of the children with multiple abscesses, 23 had abscesses confined to one lobe of the liver and 10 had involvement of both lobes of the liver. 86 children had culture of liver abscesses done and only 63 (73.2%) yielded positive culture. Staphylococcus aureus and Escherichia coli were the commonest organisms cultured from liver abscesses. 72 cases had drainage of liver abscesses, one of them ended up with hepatic artery ligation. A further 15 cases treated by PTHD survived. Of the remaining 49 cases who had antibiotic therapy, 2 died of septicemia, giving a mortality rate of 1.47%. 36.3% of children with liver abscesses responded to antibiotic therapy. The indication and method for surgical management are discussed. Percutaneous transhepatic drainage (PTHD) of liver abscesses, under the guidance of ultrasonography is found to be safe and effective.