Pyogenic hepatic abscess. Changing trends over 42 years

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).

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).