Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: An increasing problem in Eastern Asia

Table 1 Documented cases collected from the international literature

Country/region	No. of cases	No. of articles
Eastern Asia
Japan	40	36[6-10]1
China	26	6[4,5,11-14]
Korea	8	1[15]
Singapore	3	1[16]
Middle East and Europe
Israel	3	3[17-19]
Italy	2	2[20,21]
Spain	2	2[22,23]
Portugal	1	1[24]
France	1	1[25]
United Kingdom	1	1[26]
North and Central America
United States	7	7[2,27-32]
Canada	1	1[33]
Netherlands Antilles	1	1[34]
Total	96	63

¹Other 33 cases reported in a Japanese article reference were included[8].

Table 2 Constituent ratio of pus bacterial cultures n (%)

Pathogens	Eastern Asia	Non-Eastern Asia	Total
	(n = 49)	(n = 9)	(n = 58)
Bacteria
Gram negative bacteria
Klebsiella pneumoniae	28 (57.14)	1 (11.1)	29 (50.0)
Fusobacterium species	4 (8.16)	0	4 (6.90)
Bacteroides species	2 (4.08)	1 (11.1)	3 (5.17)
Escherichia coli	0	1 (11.1)	1 (1.72)
Pseudomonas aeruginosa	1 (2.04)	0	1 (1.72)
Gram positive bacteria
Streptococcus species	1 (2.04)	3 (33.3)	4 (6.90)
Enterococcus faecium	2 (4.08)	0	2 (3.44)
Polymicrobial	0	2 (22.2)1	2 (3.44)
Amoebae	2 (4.08)	0	2 (3.44)
Negative	9 (18.37)	1 (11.1)	10 (17.24)

¹Pus cultures showed mixed infection in two patients: E. corrodens, Candida albicans and Candida glabrata; Peptostreptococcus anaerobius, Bacteroides melaninogenicus and Peptostreptococcus spp.

Table 3 Treatment for liver abscess complicated with colorectal carcinoma

Sex	Age, yr	Count of abscess	Anti-infection treatment	Surgical treatment	Ref.
Female	46	Mutiple1	Cephalosporin	Sigmoidectomy	[4]
Female	79	Single	Carbapenem	PTAD + low anterior rectal resection	[5]
Male	66	Single	Broad spectrum antibiotic6	PTAD + low anterior rectal resection	[6]
Male	73	Single	Broad spectrum antibiotic6	PTAD + sigmoidectomy	[7]
Male	65	Single	Broad spectrum antibiotic6	PTAD	[7]
Male	67	Single	Broad spectrum antibiotic6	PTAD	[7]
Male	81	Mutiple	Broad spectrum antibiotic6	Laparoscopic-assisted sigmoidectomy	[8]
Male	67	Mutiple2	Cephalosporin	PTAD + polypectomy under colonscopy	[11]
Male	67	Single	Broad spectrum antibiotic6	PTAD + polypectomy under colonscopy	[12]
Female	84	Single	Broad spectrum antibiotic6	None7	[12]
Female	82	Mutiple3	Cephalosporin	PTAD + sigmoidectomy	[13]
Female	57	Single	Cephalosporin + carbapenem + moxifloxacin + gentamicin	PTAD + sigmoidectomy + chemotherapy	[14]
Female	68	Single	Cephalosporin	PTAD + low anterior rectal resection	[16]
Male	67	Single	Cephalosporin	Polypectomy under colonscopy	[16]
Male	77	Single4	Cephalosporin + ciprofloxacin + gentamicin	PTAD7	[16]
Female	66	Single	Broad spectrum antibiotic6	PTAD + sigmoidectomy	[18]
Male	64	Single	Broad spectrum antibiotic6	PTAD + right hemi-colectomy + partial hepatectomy	[19]
Male	60	Mutiple	Piperacillin + aminoglycoside	Right hemi-colectomy	[20]
Female	50	Single	Broad spectrum antibiotic6	Right hemi-colectomy + partial hepatectomy + chemotherapy	[21]
Male	68	Three	Amoxicillin + clavulanic acid	PTAD + sigmoidectomy	[22]
Male	72	Single	Cephalosporin + metronidazole + gentamicin	PTAD + right hemi-colectomy	[23]
Male	64	Two	Cephalosporin + metronidazole	Sigmoidectomy and radiotherapy	[24]
Female	82	Single	Cephalosporin +metronidazole	PTAD	[26]
Male	52	Mutiple5	Broad spectrum antibiotic6	Sigmoidectomy + chemotherapy + gemcitabine	[32]
Male	55	Single	Ampicillin + sulbactam + gentamicin	PTAD + sigmoidectomy	[34]

¹Patient had endophthalmitis with brain, lung abscesses complicated with liver abscesses;

²Patient developed S. bovis bacteremia with complications of endocarditis, osteomyelitis and silent splenic abscess after four episodes of Klebsiella pneumoniae liver abscess within 3 years;

³Patient experienced three episodes of liver abscess within 1 year;

⁴Complicated with pulmonary infections;

⁵Patient experienced two episodes of liver abscess within 3 mo;

⁶Details were not recorded;

⁷Patients refused to have further treatments. PTAD: Percutaneous transhepatic abscess drainage.

Table 4 Different therapy for colorectal cancer related liver abscess patients n (%)

	No. of patients		P value
	Antibiotics alone(n = 16)	Antibiotics + drainage (n = 42)
Gender			0.057
Male	13 (81.2)	23 (54.8)
Female	3 (18.8)	19 (45.2)
Age (yr)			0.631
< 60	2 (12.5)	5 (11.9)
> 60	14 (87.5)	37 (88.1)
Geographic distribution			0.564
Eastern Asia	13 (81.2)	35 (83.3)
Non-Eastern Asia	3 (18.8)	7 (16.7)
Pathogen			0.498
K. pneumoniae	6 (37.5)	14 (33.3)
Non-K. pneumoniae	16 (62.5)	28 (66.7)

K. pneumoniae: Klebsiella pneumoniae.