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Increased incidence of and microbiologic changes in pyogenic liver abscesses in the Mexican population
Juanita Pérez-Escobar1, Wagner Ramirez-Quesada1, Daniel Alejandro Calle-Rodas1
1Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
Background:
Pyogenic liver abscess (PLA) is a rare disease with an estimated incidence that varies widely across the globe, being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada. Even though there are multiple microorganisms capable of producing an abscess in the liver, including Entamoeba histolytica, fungi, and viruses, most abscesses are derived from bacterial infections. The epidemiology of PLA in Mexico is currently unknown.
Aim:
To describe the clinical, demographic and microbiologic characteristics of PLA in Mexico.
Methods:
This is a retrospective study carried out in two centers, and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess. We collected demographic, clinical, and microbiological information, treatment, complications, and outcomes. A logistic regression analysis was used to determine the association between different variables and mortality rates.
Results:
A total of 345 patients were included in this study. 233 (67.5%) had confirmed PLA, 133 (30%) patients had no positive culture and negative serology and 9 (2.5%) had mixed abscesses. The mean age was 50 years (ranging from 16-97 years) and 63% were female. 65% of the patients had positive cultures for Extended Spectrum Beta-Lactamases (ESBL)-Escherichia coli and Klebsiella pneumoniae. Cefotaxime was administered in 60% of cases. The most common sources of infection were ascending cholangitis and cholecystitis in 34 (10%) and 31 (9%), respectively. The median length of hospital stay was 14 d. 165 patients underwent percutaneous catheter drainage. The inpatient mortality rate was 63%. Immunocompromised state [OR 3.9, 95%CI: 1.42-10.46], ESBL- Escherichia coli [OR 6.7, 95%CI: 2.7-16.2] and Klebsiella pneumoniae [OR 4-8, 95%CI: 1.6-14.4] predicted inpatient mortality by multivariate analysis.
Conclusion:
The prevalence of PLA is increasing in Mexico and has a very high mortality rate. ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
Insights
Pyogenic liver abscess (PLA) is rising in Mexico, with high mortality. Extended Spectrum Beta-Lactamases (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are key causes and predict mortality.
Area of Science:
- Hepatology
- Infectious Diseases
- Epidemiology
Background:
- Pyogenic liver abscess (PLA) is a rare condition with variable global incidence.
- Bacterial infections are the primary cause of PLA, though other pathogens exist.
- The epidemiology of PLA in Mexico was previously undocumented.
Purpose of the Study:
- To characterize the clinical, demographic, and microbiological features of PLA in Mexico.
- To identify risk factors associated with mortality in PLA patients.
Main Methods:
- Retrospective study of 345 patients diagnosed with PLA between 2006 and 2018 across two centers.
- Data collected included demographics, clinical presentation, microbiology, treatment, complications, and outcomes.
- Logistic regression analysis was employed to determine predictors of mortality.
Main Results:
- The study included 345 patients, with 67.5% having confirmed PLA.
- The most common causative agents were Extended Spectrum Beta-Lactamases (ESBL)-producing Escherichia coli and Klebsiella pneumoniae (65%).
- Inpatient mortality was high at 63%, with immunocompromised status, ESBL- E. coli, and K. pneumoniae independently predicting mortality.
Conclusions:
- PLA prevalence is increasing in Mexico, associated with a high mortality rate.
- ESBL-producing E. coli and K. pneumoniae are prevalent pathogens in Mexican PLA cases.
- These specific bacterial strains are significant independent predictors of inpatient mortality in PLA.
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