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Pyogenic hepatic abscess. Changing trends over 42 years

C J Huang1, H A Pitt, P A Lipsett

  • 1Department of Surgery, Taichung Veterans General Hospital, Taiwan.

Annals of Surgery
|May 1, 1996
PubMed
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Pyogenic hepatic abscess management has evolved, with increased incidence and malignancy links. Despite challenges, mortality has decreased significantly due to advances in diagnosis and treatment.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Surgical Gastroenterology

Background:

  • Pyogenic hepatic abscess presents a significant mortality risk.
  • Advancements in imaging (ultrasound, CT) and percutaneous drainage have transformed diagnosis and treatment.
  • Increased incidence is linked to aggressive management of hepatobiliary and pancreatic neoplasms.

Purpose of the Study:

  • To document shifts in the etiology, diagnosis, bacteriology, treatment, and outcomes of pyogenic hepatic abscesses over four decades.
  • To compare patient cohorts from 1952-1972 with those from 1973-1993.

Main Methods:

  • Retrospective review of 233 patients with pyogenic liver abscesses.
  • Comparison of two treatment periods: 1952-1972 (n=80) and 1973-1993 (n=153).

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Main Results:

  • Incidence of pyogenic hepatic abscess increased from 13 to 20 per 100,000 hospital admissions between the two periods.
  • The later period showed a higher association with underlying malignancy (52% vs. 28%), particularly hepatobiliary/pancreatic cancers.
  • Increased prevalence of streptococcal and Pseudomonas infections, as well as mixed bacterial/fungal infections, was observed.
  • Percutaneous drainage became more common (45% vs. 0%), and overall mortality significantly decreased from 65% to 31%.
  • Mortality reduction was most pronounced in patients with multiple abscesses or biliary etiology.
  • Mixed bacterial and fungal infections were associated with increased mortality (50%).

Conclusions:

  • Significant evolution in pyogenic hepatic abscess management over 40 years.
  • Despite advances, mortality remains high, underscoring the complexity of treatment.
  • Optimal outcomes require appropriate antibiotics, antifungal agents, and effective drainage (surgical, percutaneous, or biliary).