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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical predictors of multidrug-resistant Gram-negative pyogenic liver abscess and nomogram construction: A retrospective analysis
Ke Xu, Dong-Hui Wu, Chu-Jia Zeng, Jia-Yi Guo, De-Yang Xi, Meng-Jiao Wang, Zhi-Yuan Yao, An-Qiang Feng, Fang Ji, Xue-Bing Yan, Li-Li Ye, Chun-Yang Li
Ke Xu, Dong-Hui Wu, Chu-Jia Zeng, Jia-Yi Guo, Zhi-Yuan Yao, Graduate School, Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
De-Yang Xi, Department of Intensive Care Unit, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
Meng-Jiao Wang, Department of Gastroenterology, Beilun District People’s Hospital, Ningbo 315800, Zhejiang Province, China
An-Qiang Feng, Department of Digestive Disease, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
Fang Ji, Xue-Bing Yan, Chun-Yang Li, Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221132, Jiangsu Province, China
Li-Li Ye, Department of Pediatrics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
Co-first authors: Ke Xu and Dong-Hui Wu.
Co-corresponding authors: Li-Li Ye and Chun-Yang Li.
Author contributions: Xu K and Wu DH share co-first authorship based on their equivalent substantive contributions to experimental execution and analytical rigor throughout this collaborative research; Li CY and Xu K contributed to the study design; Xu K conducted literature screening, quality assessment, and manuscript drafting; Xu K, Wu DH, and Zeng CJ performed statistical analyses; Guo JY executed literature mining; Wu DH, Xi DY, Wang MJ, Yao ZY, Feng AQ, and Ye LL conducted data analysis; Li CY, Yan XB, and Ye LL edited manuscript; Ji F provided conceptual guidance and secured funding; Li CY and Ye LL share co-corresponding authorship for their joint leadership in research coordination, intellectual direction, and conceptual innovation, reflecting the project’s collaborative ethos. All authors reviewed and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of The Affiliated Hospital of Xuzhou Medical University, No. XYFY2025-KL262-01.
Informed consent statement: Due to the retrospective and observational nature of the study without active interventions, the institutional review board waived the necessity of obtaining individual informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Chun-Yang Li, PhD, Chief Physician, Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, No. 9 Kunpeng North Road, Economic and Technological Development Zone, Xuzhou 221132, Jiangsu Province, China.
lichunyangyelili@126.com
Received: July 29, 2025
Revised: August 19, 2025
Accepted: October 14, 2025
Published online: November 14, 2025
Processing time: 108 Days and 1.5 Hours
BACKGROUND
In recent years, there has been a significant increase in pyogenic liver abscesses (PLAs) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB), predominantly Klebsiella pneumoniae and Escherichia coli.
AIM
To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs, develop a predictive nomogram for personalized risk assessment, and enhance the timeliness of empirical antibiotic selection.
METHODS
Based on the antibiotic susceptibility profiles, enrolled patients were divided into two groups: A MDR group comprising 105 individuals and a non-resistant group comprising 163 individuals. A systematic collection of demographic characteristics, laboratory findings, and prognostic indicators was performed. A predictive nomogram was established using multivariate stepwise regression modeling. Model effectiveness was evaluated by examining its discriminative capability, calibration accuracy, and clinical utility through receiver operating characteristic curves with corresponding area under the curve values, calibration graphs, and decision curve analysis. Continuous data were analyzed using the independent-sample t-test if they met normality criteria; otherwise, the Wilcoxon rank-sum test was adopted. For categorical data, Fisher’s exact test was chosen when the expected count in any cell was below five; in all other instances, the χ2 test was applied.
RESULTS
This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025. Among these, 105 cases (39%) were associated with MDR-GNB, primarily Klebsiella pneumoniae (43%) and Escherichia coli (42%). Mixed infections were rare, accounting for only 3% of cases. Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses: Age ≥ 60 years, diabetes, presence of a malignant tumor, lower C-reactive protein levels, and prolonged prothrombin time. These variables were integrated into a nomogram to facilitate individualized risk assessment.
CONCLUSION
The results imply that being aged over 60, diabetes, malignant tumor, lower C-reactive protein levels, and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs, highlighting the importance of early screening to enable more targeted antibiotic treatments. However, as this was a single-center study without external validation, the generalizability of our model remains limited. Future multicenter, multi-ethnic prospective studies are needed to validate and extend these findings.
Core Tip: This study identifies age ≥ 60, diabetes, malignant tumor, lower C-reactive protein levels, and prolonged prothrombin time as independent predictors of multidrug-resistant Gram-negative bacteria pyogenic liver abscess, primarily caused by Klebsiella pneumoniae and Escherichia coli. A validated nomogram incorporating these factors enables personalized risk assessment, facilitating early screening and optimized empirical antibiotic therapy for enhanced clinical outcomes. Findings are based on retrospective analysis of 268 Gram-negative pyogenic liver abscess cases.
