Klebsiella pneumoniae as leading cause of pyogenic liver abscess: Three years study in Southern Vietnam

doi:10.4254/wjh.v18.i2.113695

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Feb 27, 2026 (publication date) through Feb 12, 2026

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Hepatol. Feb 27, 2026; 18(2): 113695
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.113695

Klebsiella pneumoniae as leading cause of pyogenic liver abscess: Three years study in Southern Vietnam

Tuong-Anh Mai-Phan, Khanh-Phat Thai, Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, Phu-Cuong Pham, Nhu Ngoc-Quynh Duong, My-Tran Trinh, Nguyen-Khoi Le

Tuong-Anh Mai-Phan, Khanh-Phat Thai, Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, Phu-Cuong Pham, My-Tran Trinh, Nguyen-Khoi Le, Department of Hepato-Pancreato-Biliary Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh 700000, Viet Nam

Kim-Long Le, Tri-Nhan Pham, Minh-Quang Tran, Phu-Cuong Pham, My-Tran Trinh, Nguyen-Khoi Le, Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh 700000, Viet Nam

Nhu Ngoc-Quynh Duong, Department of Gastroenterology Surgery, Ho Chi Minh City Medicine and Pharmacy University, Ho Chi Minh 700000, Viet Nam

Co-first authors: Tuong-Anh Mai-Phan and Khanh-Phat Thai.

Co-corresponding authors: Kim-Long Le and Nguyen-Khoi Le.

Author contributions: Mai-Phan TA and Thai KP conceived the study concept and were responsible for the overall study design, and they contributed equally to this manuscript and are co-first authors; Mai-Phan TA, Thai KP, Pham PC, and Trinh MT conducted the literature search, data acquisition, and data extraction; Mai-Phan TA, Le KL, and Le NK prepared the figures, tables, and assisted with manuscript organization; Mai-Phan TA and Le NK provided critical revisions, language editing, and formatting; Le KL coordinated the writing process, supervised the project, and approved the final version of the manuscript; Le KL, Pham TN, Tran MQ, and Duong NNQ contributed to data analysis, interpretation, and drafting of the initial manuscript; Le KL and Le NK contributed equally to this manuscript and are co-corresponding authors.

Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Nhan Dan Gia Dinh Hospital (Approval No. 63/NDGĐ-HĐĐĐ), and all procedures complied with the ethical standards outlined in the Declaration of Helsinki.

Informed consent statement: Informed consent was not required for this retrospective study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to institutional data protection policies but are available from the corresponding author upon reasonable request and with permission from Nhan Dan Gia Dinh Hospital’s Institutional Review Board.

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: Kim-Long Le, MD, Doctorate Student, Lecturer, Department of Surgery, Faculty of Medicine, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung, Hoa Hung Ward, Ho Chi Minh 700000, Viet Nam. longlk@pnt.edu.vn

Received: September 1, 2025
Revised: October 6, 2025
Accepted: December 5, 2025
Published online: February 27, 2026
Processing time: 164 Days and 21.6 Hours

Abstract

BACKGROUND

Pyogenic liver abscess (PLA) is increasingly recognized worldwide. In Asia, Klebsiella pneumoniae (K. pneumoniae) has emerged as the predominant pathogen, yet contemporary data from Vietnam remain limited.

AIM

To determine the microbial spectrum of PLA and compare clinical, computed tomography (CT), management, and outcomes between K. pneumoniae and non-K. pneumoniae cases in Southern Vietnam.

METHODS

This retrospective cohort included adults with PLA managed at Nhan Dan Gia Dinh Hospital from June 2021 to June 2024. Of 123 cases, 17 were excluded (8 with unspecified Gram-negative bacilli, 9 without CT), leaving 106 patients (83 K. pneumoniae, 23 non-K. pneumoniae). Data on demographics, comorbidities, presentation, laboratory, imaging, microbiology, treatment, and outcomes were analyzed using standard parametric/nonparametric and χ²/Fisher tests (two-sided α = 0.05).

RESULTS

Mean age was 59.2 years, and 67.0% were male. Diabetes was more frequent in K. pneumoniae (55.4% vs 30.4%; P = 0.034). C-reactive protein was higher in K. pneumoniae but not significant (229.9 mg/L vs 185.0 mg/L; P = 0.069). Aspartate aminotransferase was significantly elevated (P = 0.048) and alanine aminotransferase borderline (P = 0.065). On CT, K. pneumoniae abscesses more often had irregular margins (P = 0.038) and heterogeneous architecture (P = 0.003). K. pneumoniae predominated in pus (71.9%) and blood (78.6%) cultures. Source-control and hospital stay were similar. Mortality was 10.4% overall, occurring only in K. pneumoniae (13.3% vs 0%). Older age predicted poorer survival (odds ratio = 0.95; P = 0.029).

CONCLUSION

In Southern Vietnam, K. pneumoniae predominates in PLA, characterized by distinctive CT features and higher mortality, emphasizing early recognition, pathogen-directed therapy, and timely image-guided drainage.

Keywords: Pyogenic liver abscess; Klebsiella pneumoniae; Diabetes mellitus; Computed tomography; Vietnam

Core Tip: This three-year study from a tertiary hospital in Southern Vietnam shows that Klebsiella pneumoniae (K. pneumoniae) is now the leading cause of pyogenic liver abscess, responsible for nearly 80 percent of cases. Patients with K. pneumoniae infection were more likely to have diabetes, higher inflammatory markers, and typical computed tomography findings with irregular margins and heterogeneous internal structure. All deaths in this cohort occurred in the K. pneumoniae group. These results highlight the importance of early antibiotic coverage active against K. pneumoniae, timely image-guided drainage, and close clinical monitoring in areas where this organism is common.