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[Surgical-radiologic interventional treatment in liver abscess with Streptococcus anginosus Milleri]
1Universitätsklinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Abstract:
Pyogenic liver abscess is a relatively rare disease, often concerning elderly patients in bad general condition and with underlying diseases. Out of a retrospective study (1984-1991) of 44 patients (f 43%, m 57%) with pyogenic liver abscesses and 12 patients (f 17%, m 83%) with amebic liver abscesses we present 5 patients with multifocal lesions due to Streptococcus anginosus Milleri--a special group concerning therapy and course of disease. The therapy was high-dose i.v. antibiotic therapy in all 5 cases and additional percutaneous drainage with pig-tail catheters--inserted under CT guidance--in 4 cases (1-5 catheters, time of drainage 6-63 days). The duration of hospitalisation was 15-73 days (median 45), intravenous antibiotic treatment lasted 4-40 days. After discharge oral antibiotics were continued for 14-42 days.
Insights
Multifocal pyogenic liver abscesses caused by Streptococcus anginosus Milleri require intensive treatment. This includes high-dose intravenous antibiotics and percutaneous drainage, leading to prolonged hospitalization and recovery periods.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Pyogenic liver abscess (PLA) is a rare condition, frequently affecting elderly patients with comorbidities.
- This study focuses on a specific subset of PLA patients with multifocal lesions.
- Compares pyogenic liver abscesses (PLA) with amebic liver abscesses (ALA).
Purpose of the Study:
- To describe the clinical characteristics, treatment, and outcomes of patients with multifocal liver abscesses.
- To highlight the role of Streptococcus anginosus Milleri in causing complex liver abscesses.
- To analyze the therapeutic strategies and disease course in this specific patient group.
Main Methods:
- Retrospective analysis of 44 PLA and 12 ALA cases from 1984-1991.
- Detailed examination of 5 patients with multifocal lesions due to Streptococcus anginosus Milleri.
- Review of treatment protocols including high-dose intravenous antibiotics and CT-guided percutaneous drainage.
Main Results:
- Five patients presented with multifocal lesions caused by Streptococcus anginosus Milleri.
- All five patients received high-dose intravenous antibiotic therapy.
- Four patients underwent percutaneous drainage with 1-5 catheters (drainage duration: 6-63 days).
- Hospitalization ranged from 15-73 days (median 45 days); intravenous antibiotics lasted 4-40 days.
- Oral antibiotics were continued post-discharge for 14-42 days.
Conclusions:
- Streptococcus anginosus Milleri can cause multifocal pyogenic liver abscesses requiring aggressive management.
- Effective treatment involves high-dose intravenous antibiotics and often percutaneous drainage.
- Patients require extended treatment durations, including prolonged hospitalization and post-discharge oral antibiotic courses.