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[Pyogenic liver abscess: Changes of Organisms and Consequences for Diagnosis and Therapy]
Abstract:
Liver abscess is a rare but potentially fatal disease with mortality rates of 2 - 12 %. The spectrum of causative microorganisms varies across the world and is changing due to increasing worldwide travel activity. As a result, previously less frequent pathogens must increasingly be considered in the differential diagnosis. The most common pathogens of liver abscess are so-called abscess streptococci, anaerobes and Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. Certain clones among the Gram-negatives, typically among Klebsiella spp., harbour specific virulence factors and are therefore referred to as hypervirulent clones which spread worldwide. In any case, the causative agent should be identified before anti-infective treatment is initiated. Several pathogens such as Candida spp., Pseudomonas aeruginosa or Staphylococcus aureus are uncommon and only detected in a specific context. Various therapeutic regimens are available for anti-infective therapy. Usually an empirical therapy is started, combining mostly β-lactam antibiotics or quinolones with anaerobically active substances.
Insights
Liver abscess, a serious infection, is caused by diverse bacteria like E. coli and Klebsiella pneumoniae, with changing global patterns. Prompt identification of the pathogen is crucial for effective treatment.
Area of Science:
- Infectious Diseases
- Microbiology
- Hepatology
Background:
- Liver abscess presents a significant mortality risk (2-12%).
- Global travel influences the spectrum of causative microorganisms, necessitating consideration of less common pathogens.
- Commonly implicated pathogens include abscess streptococci, anaerobes, and Gram-negative bacteria like Escherichia coli and Klebsiella pneumoniae.
Purpose of the Study:
- To highlight the evolving landscape of liver abscess pathogens.
- To emphasize the importance of pathogen identification prior to treatment.
- To discuss current therapeutic strategies for liver abscess.
Main Methods:
- Review of current literature on liver abscess etiology and treatment.
- Analysis of changing trends in microbial spectrum due to global travel.
- Discussion of diagnostic and therapeutic approaches.
Main Results:
- The spectrum of liver abscess pathogens is dynamic and influenced by international travel.
- Hypervirulent clones, particularly within Klebsiella spp., are emerging global concerns.
- Prompt microbiological diagnosis is essential for targeted anti-infective therapy.
Conclusions:
- Liver abscess management requires awareness of evolving microbial epidemiology.
- Empirical therapy often involves broad-spectrum antibiotics targeting common and anaerobic pathogens.
- Further research into specific pathogen virulence factors and resistance patterns is warranted.
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