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A Multicenter Retrospective Study on Clinical Characteristics and Outcome of Pyogenic Liver Abscess Focusing
Ji-Won Park1,2, Jung-Hee Kim3, Jang-Han Jung3
1Department of Internal Medicine, Hallym University Sacred Heart Hospital of Hallym University Medical Center, 22, Gwanpyeong-ro 170 Beon-gil, Anyang-si 14068, Korea.
Abstract:
The emergence of multidrug-resistant organisms (MDROs) is a growing problem worldwide. However, little is known about the incidence, clinical features and outcomes of pyogenic liver abscesses (PLAs) caused by MDROs. A retrospective study of 833 patients with PLA admitted from 2008 to 2017 was performed. MDROs were found in 55 (6.6%) patients, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was the most common causative microorganism. To evaluate the clinical features of and risk factors for MDRO-induced PLAs, propensity score matching (PSM) was performed in a 1:3 ratio (55 patients with MDROs and 165 patients without MDROs). After PSM, previous hepatobiliary procedure, preadmission exposure to antibiotics and elevated alkaline phosphatase levels were independent risk factors for MDRO-induced PLA. Sixteen patients (7.3%) died during hospitalization. Admission to intensive care unit (ICU), inadequate initial antibiotic treatment and use of inotropic agents were factors predictive of mortality. Although the presence of MDROs was not associated with in-hospital mortality, inadequate initial antibiotic treatment was prescribed to a large portion of the patients with MDRO-induced PLAs. We conclude that initial empirical antibiotic therapy for PLA should be based on the possibility of infection with MDROs, and close monitoring is necessary for patients with risk factors for in-hospital mortality.
Insights
Multidrug-resistant organisms (MDROs) are increasingly causing pyogenic liver abscesses (PLAs). Inadequate initial antibiotic treatment is common in MDRO-PLA cases, necessitating updated empirical therapy and close patient monitoring.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Multidrug-resistant organisms (MDROs) pose a significant global health threat.
- Pyogenic liver abscesses (PLAs) are serious infections with limited data on MDRO involvement.
- Understanding MDRO-PLA epidemiology and risk factors is crucial for effective management.
Purpose of the Study:
- To investigate the incidence, clinical characteristics, and outcomes of PLAs caused by MDROs.
- To identify risk factors associated with MDRO-induced PLAs.
- To evaluate factors predicting mortality in PLA patients.
Main Methods:
- Retrospective study of 833 PLA patients (2008-2017).
- Propensity score matching (PSM) for comparing MDRO and non-MDRO groups (1:3 ratio).
- Analysis of clinical features, risk factors, and mortality predictors.
Main Results:
- MDROs identified in 6.6% of PLA cases; extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae were most common.
- PSM revealed prior hepatobiliary procedures, preadmission antibiotic exposure, and elevated alkaline phosphatase as PLA risk factors.
- In-hospital mortality was 7.3%; ICU admission, inadequate initial antibiotics, and inotropic agent use predicted mortality.
Conclusions:
- MDROs are an emerging cause of PLAs, with specific risk factors identified.
- While MDROs did not directly increase mortality, inadequate initial antibiotic treatment was prevalent in MDRO-PLA patients.
- Empirical antibiotic strategies for PLA should consider MDROs, and high-risk patients require vigilant monitoring.
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