Fiore M. Letter to the Editor: From prediction to prevention: Integrating nomograms and pathogen biology in multidrug-resistant pyogenic liver abscess. World J Hepatol 2026; 18(5): 115709 [DOI: 10.4254/wjh.v18.i5.115709]
Corresponding Author of This Article
Marco Fiore, MD, PhD, Lecturer, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it
Research Domain of This Article
Infectious Diseases
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letter
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Fiore M. Letter to the Editor: From prediction to prevention: Integrating nomograms and pathogen biology in multidrug-resistant pyogenic liver abscess. World J Hepatol 2026; 18(5): 115709 [DOI: 10.4254/wjh.v18.i5.115709]
World J Hepatol. May 27, 2026; 18(5): 115709 Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.115709
Letter to the Editor: From prediction to prevention: Integrating nomograms and pathogen biology in multidrug-resistant pyogenic liver abscess
Marco Fiore
Marco Fiore, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Author contributions: Fiore M wrote the paper.
Conflict-of-interest statement: The author declares no conflict of interest.
Corresponding author: Marco Fiore, MD, PhD, Lecturer, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it
Received: October 24, 2025 Revised: January 2, 2026 Accepted: January 22, 2026 Published online: May 27, 2026 Processing time: 215 Days and 13 Hours
Abstract
The increasing incidence of multidrug-resistant (MDR) Gram-negative pyogenic liver abscess (PLA) is reshaping diagnostic and therapeutic paradigms in hepatobiliary medicine. The study by Xu et al, published in the recent issue of the World Journal of Gastroenterology, developed a predictive nomogram incorporating five independent factors-advanced age, diabetes, malignancy, lower C-reactive protein levels, and prolonged prothrombin time-to estimate individualized MDR risk. This letter critically examines the methodological and clinical implications of that model, discussing how predictive analytics may evolve into preventive frameworks when combined with biological insight and stewardship integration. The proposed nomogram is a practical bedside instrument that operationalizes MDR risk estimation in clinical environments increasingly dominated by Klebsiella pneumoniae and Escherichia coli. Its discrimination is robust, though single-center derivation constrains external validity. Augmenting predictive accuracy through dynamic biomarkers-such as interleukin-6 and procalcitonin-could better capture host-response kinetics. Mechanistic evidence indicates that MDR strains’ enhanced virulence (biofilm formation, siderophore-mediated iron uptake, capsule hyperexpression) supports integrating pathogen biology into prediction. Embedding risk models within antimicrobial stewardship pathways may promote timely source control, rational empiric therapy, and structured de-escalation. Beyond statistical modeling, innovation lies in transforming prediction into prevention. Multicenter validation, genomic correlation, and digital recalibration will determine whether predictive tools can reduce MDR-PLA burden. Aligning data-driven analytics with infection biology and governance can shift hepatology from reactive treatment toward proactive resistance prevention.
Core Tip: Xu et al proposed a bedside nomogram to estimate the probability of multidrug-resistant (MDR) Gram-negative pyogenic liver abscess (PLA) using five routinely available variables. This letter clarifies how such risk stratification can be operationalized at the bedside through concrete clinical scenarios, while arguing that prediction becomes clinically meaningful only when coupled to actionable pathways: Early imaging and source control, rapid resistance-gene testing where available, guideline-concordant empiric coverage in high-risk patients, and stewardship-driven de-escalation. Integrating host vulnerability with pathogen biology may allow hepatology services to move from delayed recognition to prevention-oriented management of MDR-PLA.
