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Long HY, Yan X, Meng JX, Xie F. Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data. World J Gastrointest Surg 2025; 17:104615. [DOI: 10.4240/wjgs.v17.i4.104615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 01/24/2025] [Accepted: 02/20/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Effective management of liver abscess depends on timely drainage, which is influenced by the liquefaction degree. Identifying predictive factors is crucial for guiding clinical decisions.
AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.
METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage. Patients were divided into a poor liquefaction group (n = 28) and a well liquefaction group (n = 82) based on the ratio of postoperative 24-hour drainage volume to abscess volume, using a cutoff value of 0.3. Clinical characteristics, laboratory indicators, and computed tomography imaging features were compared. A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.
RESULTS Independent predictive factors for good liquefaction included the absence of diabetes [odds ratio (OR) = 0.339, P = 0.044], absence of pneumonia (OR = 0.218, P = 0.013), left-lobe abscess location (OR = 4.293, P = 0.041), cystic features (OR = 5.104, P = 0.025), and elevated preoperative serum alanine aminotransferase (ALT) levels (OR = 1.013, P = 0.041). The logistic regression model based on these factors demonstrated an area under the curve of 0.814, with a sensitivity of 90.24% and specificity of 67.86%. Five-fold cross-validation yielded an average accuracy of 83.61% and a kappa coefficient of 0.5209.
CONCLUSION Pneumonia, diabetes, abscess location, abscess composition, and preoperative serum ALT levels are significant predictors of liver abscess liquefaction. The model can guide clinical decision-making.
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Affiliation(s)
- Hong-Yu Long
- Department of Radiology, The People’s Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China
| | - Xin Yan
- Department of Imaging 1, The Rehabilitation Hospital of Shaanxi Province, Xi’an 710065, Shaanxi Province, China
| | - Jia-Xian Meng
- Department of Science and Education, The People’s Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China
| | - Feng Xie
- Department of Interventional Medicine, Jin Qiu Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China
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2
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Zhang HF, Chen JW, Li SS, Wu SW, Li S, Liu CY, Cai C, Lu MQ. Analysis of clinical characteristics of elderly patients with blood culture-positive bacterial liver abscess. Front Med (Lausanne) 2025; 12:1555056. [PMID: 40182839 PMCID: PMC11965363 DOI: 10.3389/fmed.2025.1555056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 03/10/2025] [Indexed: 04/05/2025] Open
Abstract
Objective To analyze the clinical features of elderly patients with blood culture-positive bacterial liver abscess (BLA) and improve diagnostic and treatment strategies. Methods Elderly BLA patients admitted to our hospital from December 2018 to December 2023 were included in the study. Diagnostic tests included routine blood analysis, biochemistry, C-reactive protein (CRP), procalcitonin (PCT), imaging, and cultures of blood or pus. Treatments involved anti-infective therapy, ultrasound-guided abscess drainage, and supportive care. Results (1) Elderly patients with blood culture-positive BLA had higher rates of prolonged hospital stays (≥2 weeks), ICU admission, biliary system diseases, hepatitis B infection, maximum body temperature ≥ 39°C, and qSOFA scores ≥2 compared to controls (p < 0.05)0. (2) Laboratory findings showed higher levels of total bilirubin (≥34.2 μmol/L), ALT (≥50 U/L), serum creatinine (≥80 μmol/L), PCT (≥5 ng/mL), and lower platelet counts (≤100 × 109/L) in the research group (p < 0.05). ESBL-positive cases and liver abscesses ≤5 cm were more common in the research group (p < 0.05). (3) Complications such as pleural effusion, ascites, pulmonary infections, and extrahepatic abscesses were significantly more frequent in the blood culture-positive group (p < 0.05). (4) Microbiological analysis indicated that Klebsiella pneumoniae was the leading pathogen (87.93%), followed by Escherichia coli. For ESBL-positive infections, E. coli was dominant (75.76%), especially in patients with biliary diseases (75.56%). (5) Logistic regression identified prolonged hospital stay, hepatitis B infection, biliary system diseases, temperature ≥ 39°C, PCT ≥5, and abscess size ≤5 cm as independent risk factors for blood culture-positive BLA. (6) The combined diagnostic indicator showed good predictive ability (AUC = 0.840, sensitivity 76.6%, specificity 72.2%). Conclusion Elderly patients with biliary diseases, hepatitis B, high PCT levels (≥5 ng/mL), small abscesses (≤5 cm), and fever (≥39°C) are at higher risk for blood culture-positive BLA. Klebsiella pneumoniae remains the predominant pathogen (87.93%), highlighting the need for prompt empirical antibiotic therapy. The combined diagnostic model offers reliable predictive value for this condition. We developed a predictive model aimed at assisting clinicians in identifying high-risk patients prone to bloodstream infections secondary to BLA. This model provides valuable guidance for clinicians in formulating more rational and individualized treatment strategies.
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Affiliation(s)
| | | | | | | | | | | | - Chao Cai
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ming-Qin Lu
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Fan Z, Mei M, Chen C. Pyogenic liver abscess and sepsis caused by mixed anaerobic bacteria in an immunocompetent adult: a case report. Front Med (Lausanne) 2025; 12:1486256. [PMID: 40018345 PMCID: PMC11864932 DOI: 10.3389/fmed.2025.1486256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 01/02/2025] [Indexed: 03/01/2025] Open
Abstract
Background Anaerobic bacterial communities in the digestive tract play an important role in digestive tract infections and aspiration pneumonia. However, ectopic infections originating from these communities are uncommon. Case report We present a rare case of a 64-year-old immunocompetent female was admitted with no significant medical history who developed a pyogenic liver abscess and sepsis caused by multiple anaerobic bacteria of digestive tract origin. Metagenomic next-generation sequencing (mNGS) detected four types of anaerobic bacteria in both peripheral blood and abscess puncture fluid. Culture confirmed the presence of three of these microorganisms. Treatment with a combination of meropenem and metronidazole resulted in the patient's subsequent recovery and discharge. Conclusion This report highlights the occurrence of ectopic infections caused by multiple anaerobic bacteria leading to pyogenic liver abscess and sepsis, underscoring the importance of considering anaerobic bacteria and conducting rapid comprehensive pathogen detection in clinical practice.
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Affiliation(s)
| | | | - Cen Chen
- Department of Respiratory Medicine, Changde Hospital, Xiangya School of Medicine, Central South University (The First people’s Hospital of Changde City), Changde, China
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Akbar PS, Marselina EV. Response to "A Validation Study of the Danish ICD-10 Diagnosis Code K75.0 for Pyogenic Liver Abscess" [Letter]. Clin Epidemiol 2025; 17:73-74. [PMID: 39911879 PMCID: PMC11796451 DOI: 10.2147/clep.s518374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 01/31/2025] [Indexed: 02/07/2025] Open
Affiliation(s)
- Prima Soultoni Akbar
- Medical Record and Health Information Department, Poltekkes Kemenkes Malang, Kota Malang, Jawa Timur, Indonesia
| | - Elystia Vidia Marselina
- Medical Record and Health Information Department, Poltekkes Kemenkes Malang, Kota Malang, Jawa Timur, Indonesia
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Cui J, Liu Y, Fu H, Cui M, Li J, Bai Z, Li J. Etiology, Risk Factors, and Antimicrobial Resistance in Recurrent Pyogenic Liver Abscesses: A Six-Year Analysis. Infect Drug Resist 2025; 18:15-23. [PMID: 39776754 PMCID: PMC11705988 DOI: 10.2147/idr.s492544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 12/23/2024] [Indexed: 01/11/2025] Open
Abstract
Aim To perform a comparative analysis of the clinical data of patients with and without recurrent pyogenic liver abscess and explore the influencing factors, clinical characteristics, and pathogenic bacteria associated with the recurrence of liver abscesses. Patients and Methods A retrospective analysis was conducted on 436 recently diagnosed patients with pyogenic liver abscess admitted to the Affiliated Hospital of Chengde Medical College between June 2017 and June 2023. Patients with recurrence comprised the observation group, whereas those without recurrence comprised the control group.This analysis included the examination of clinical characteristics, pathogens, drug resistance patterns, and treatment modalities. Additionally, regression analysis was employed to investigate the factors influencing liver abscess recurrence. Results Of 436 patients initially diagnosed with pyogenic liver abscess, 58 experienced recurrence. The proportion of Escherichia coli infection was 23.3% in the observation group and 10.3% in the control group, indicating a statistically significant difference. Multivariate analysis identified diabetes mellitus and cerebral infarction as significant risk factors for recurrent pyogenic liver abscess. Conclusion In comparison with patients without recurrence, those who experienced recurrent pyogenic liver abscess following initial diagnosis exhibited a higher prevalence of E. coli as a pathogenic bacterium. In addition, a history of diabetes mellitus and cerebral infarction are high-risk factors for with pyogenic liver abscess recurrence for the first time.
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Affiliation(s)
- JinHua Cui
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - YaMan Liu
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - Hua Fu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - MiaoHang Cui
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - JiZhong Li
- Department of Operating Room, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - ZiYu Bai
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - Jian Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
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Pillay K, Khan ZA, Nweke EE, Omoshoro-Jones J. Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals. World J Hepatol 2024; 16:1417-1428. [DOI: 10.4254/wjh.v16.i12.1417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 10/02/2024] [Accepted: 10/29/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria, fungi, and parasitic organisms. Trends in both abscess microbiology and management of abscesses (infective collections) have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income countries.
AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.
METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg, South Africa from January 2016 to December 2020 were reviewed and analyzed. All patients older than 13 years presenting with infective liver collections (pyogenic, amoebic) and hydatid disease were included. Clinical findings and laboratory, microbiology, and radiology results and outcomes were collated and analyzed.
RESULTS In total, 222 patients were included. There were 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. Comorbidities included HIV (24.23%), hypertension (20.57%), and diabetes mellitus (16.83%). The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant etiology of the pyogenic liver abscesses (PLA) was biliary-related disease. WBC and C-reactive protein were significantly higher in the pyogenic group (P < 0.0002 and P < 0.007, respectively) when compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood in 17.58% and abscess fluid in 56.60%. Klebsiella, Escherichia coli and Streptococci were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. In the overall group, 76.00% (n = 169) of patients requiring drainage had a percutaneous transhepatic catheter drain placed, while 8.76% (n = 19) had open surgery. The median length of hospital stay was 13 days. The mortality rate was 3.02%.
CONCLUSION In this study, the most common type of liver abscess was PLAs of biliary origin in middle-aged males. The microbiology was similar to those described in Asian populations, and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
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Affiliation(s)
- Krevosha Pillay
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
| | - Zafar Ahmed Khan
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
- Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
| | - Ekene Emmanuel Nweke
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
| | - Jones Omoshoro-Jones
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
- Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
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Deng WQ, Wei B, Li ZY, Liu K. Case report: Brain infarction following percutaneous drainage of a liver abscess post-chemotherapy for pancreatic head cancer. Front Med (Lausanne) 2024; 11:1453533. [PMID: 39726681 PMCID: PMC11670067 DOI: 10.3389/fmed.2024.1453533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 11/18/2024] [Indexed: 12/28/2024] Open
Abstract
Bacterial liver abscesses commonly occur in patients with immune deficiencies such as diabetes, post-chemotherapy, or post-immunosuppressive therapy. The recommended treatment for liver abscesses exceeding 5 cm in a diameter is anti-infection therapy combined with percutaneous catheter drainage. Complications may include local spread to adjacent tissues or organs and thrombosis of the liver and portal veins. Rare hematogenous spread to distant sites, such as endophthalmitis and central nervous system embolism, have been reported, though such complications are uncommon post-drainage. This case report details a patient who suffered a brain infarction shortly after percutaneous drainage of a large liver abscess.
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Affiliation(s)
- Wan-qiu Deng
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wei
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng-yan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
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8
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Dudina M, Søgaard KK, Olesen SS, Nielsen HL. A Validation Study of the Danish ICD-10 Diagnosis Code K75.0 for Pyogenic Liver Abscess. Clin Epidemiol 2024; 16:803-810. [PMID: 39588012 PMCID: PMC11587803 DOI: 10.2147/clep.s485678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 10/14/2024] [Indexed: 11/27/2024] Open
Abstract
Purpose Routinely collected clinical data are a valuable resource for epidemiological research in infectious diseases. We examined the validity of the ICD-10 diagnosis code K75.0 for pyogenic liver abscess (PLA) from hospital discharge registries. Patients and Methods This validation study was conducted in the North Denmark Region, using data from Aalborg University Hospital and the North Denmark Regional Hospital, along with their smaller regional satellite hospitals. The study period extended from January 1, 2010, to June 30, 2022, covering a catchment population of approximately 590,000 inhabitants. We identified patients with a first diagnosis (primary or secondary) of PLA (ICD-10 code K75.0) recorded in the Danish National Patient Registry and estimated the positive predictive value (PPV) of the PLA diagnosis using medical records as the reference standard. Subanalyses of PPV were conducted based on the department setting (emergency, medical, or surgical). Results A total of 297 patients received an ICD-10 diagnosis code of K75.0 during the study period. Five (2.0%) patients were excluded due to initial hospitalization outside the North Denmark Region, and 67 (23%) were misclassified. The overall PPV for the K75.0 diagnosis code during the study period was 77% (95% CI: 72-82%). The highest PPV, 88% (95% CI: 81-93%), was observed in patients diagnosed in medical departments, while the lowest PPV, 56% (95% CI: 30-80%), was observed in patients diagnosed in emergency wards. The PPV for surgical departments was 69% (95% CI: 61-77%). Conclusion The overall PPV of the ICD-10 diagnosis code K75.0 for PLA was 77%. Variability in PPVs across departments suggested differences in diagnostic accuracy, with medical departments demonstrating the highest PPV.
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Affiliation(s)
- Margarita Dudina
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Kirstine Kobberøe Søgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
| | - Søren Schou Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
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Ke Y, Jiang Y, Yuan Y, Chen Y, Huang J, Huang C. Eosinophilic gastrointestinal diseases with overall gastrointestinal tract causing liver abscess in an older patient: a case report and literature review. BMC Geriatr 2024; 24:945. [PMID: 39548381 PMCID: PMC11566447 DOI: 10.1186/s12877-024-05541-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 11/04/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND Eosinophilic gastrointestinal diseases are the rare gastrointestinal disorders. To our knowledge, there have been no reports of eosinophilic gastrointestinal diseases with overall gastrointestinal tract involvement causing liver abscess in an older patient. CASE PRESENTATION We report a 68-year-old man with eosinophilic gastrointestinal disease with overall gastrointestinal tract involvement. He was admitted with suspected acute gastroenteritis, and histological examination showed eosinophilic infiltration accompanied by liver abscess. The collected pus was tested for Metagenomics Next-Generation Sequencing and confirmed the presence of Klebsiella pneumoniae. CONCLUSIONS We conducted a literature review on the complications of eosinophilic gastrointestinal diseases and discussed how eosinophilic gastrointestinal diseases lead to liver abscess caused by Klebsiella pneumoniae.
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Affiliation(s)
- Yifan Ke
- Gastroenterology Department, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yi Jiang
- Gastroenterology Department, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yuping Yuan
- Gastroenterology Department, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yihan Chen
- Gastroenterology Department, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Jianbin Huang
- Gastroenterology Department, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Chunwei Huang
- Gastroenterology Department, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China.
- The Second Affiliated Hospital of Shanghai University, Wenzhou, Zhejiang, 325000, China.
- The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Lee J, Nam SW, Kwon JH, Shim DJ, Baek SH, Lee SK. Development of a nomogram to assess thromboembolic risk in patients with liver abscesses. Sci Rep 2024; 14:26718. [PMID: 39496713 PMCID: PMC11535388 DOI: 10.1038/s41598-024-77799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 10/25/2024] [Indexed: 11/06/2024] Open
Abstract
Thromboembolism, a serious complication in patients with liver abscesses, can lead to organ deterioration if left untreated. However, factors associated with thromboembolism in these patients remain poorly understood. We aimed to identify the factors associated with liver abscess complications, with a focus on thromboembolism and metastatic infection. Data from 325 patients diagnosed with liver abscesses between March 2019 and June 2023 were retrospectively collected. Baseline clinical and laboratory variables associated with thromboembolic events and metastatic infections were analyzed using logistic regression. A nomogram for predicting thromboembolism was constructed using significant predictors. Among the 325 patients, the median age was 68.0 years, and included 129 women. Fifty patients experienced thromboembolic events and 44 had metastatic infections. Significant predictors for thromboembolic events included white blood cell (WBC) ≥ 20,000/µL (odds ratio [OR] 3.401, p = 0.002), platelet count < 100,000/µL (OR 3.291, p = 0.004), and abscess septation (OR 2.704, p = 0.007). Age ≥ 65 years (OR 0.457, p = 0.040), WBC ≥ 20,000/µL (OR 3.340, p = 0.005), and abscess septation (OR 2.909, p = 0.008) were identified as factors associated with metastatic infections. A nomogram was constructed to predict thromboembolism using the following four variables: WBC ≥ 20,000/µL platelet count < 100,000/µL, albumin < 2.8 g/dL, and abscess septation, and demonstrated an AUROC of 0.755. Our study is the first to develop a reliable nomogram for thromboembolism prediction, utilizing easily accessible clinical parameters. This innovative model enables clinicians to efficiently identify high-risk patients, facilitating the implementation of additional studies to mitigate the risk of overlooked thromboembolic events in these at-risk individuals.
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Affiliation(s)
- Jaejun Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Woo Nam
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Jung Hyun Kwon
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hwan Baek
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Kyu Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea.
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11
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Khorasanizadeh F, Azizi N, Cannella R, Brancatelli G. An exploration of radiological signs in post-intervention liver complications. Eur J Radiol 2024; 180:111668. [PMID: 39180784 DOI: 10.1016/j.ejrad.2024.111668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
The advent and progression of radiological techniques in the past few decades have revolutionized the diagnostic and therapeutic landscape for liver diseases. These minimally invasive interventions, ranging from biopsies to complex therapeutic procedures like transjugular intrahepatic portosystemic shunt placement and transarterial embolization, offer substantial benefits for the treatment of patients with liver diseases. They provide accurate tissue diagnosis, allow real-time visualization, and render targeted treatment for hepatic lesions with enhanced precision. Despite their advantages, these procedures are not without risks, with the potential for complications that can significantly impact patient outcomes. It is imperative for radiologists to recognize the signs of these complications promptly to mitigate further health deterioration. Ultrasound, CT, and MRI are widely utilized examinations for monitoring the complications. This article presents an overarching review of the most commonly encountered hepatobiliary complications post-radiological interventions, emphasizing their imaging characteristics to improve patient post-procedure management.
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Affiliation(s)
- Faezeh Khorasanizadeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Narges Azizi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Giuseppe Brancatelli
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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12
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Wang K, Guo W, Zhu J, Guo Y, Gao W. Clinical Characteristics and Risk Factors of Sepsis in Patients with Liver Abscess. Br J Hosp Med (Lond) 2024; 85:1-15. [PMID: 39347671 DOI: 10.12968/hmed.2024.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Aims/Background Liver abscess (LA) is a serious medical condition that predisposes patients to sepsis. However, predicting sepsis in LA patients has rarely been explored. This study employed univariate and multivariate logistic regression analyses to identify independent risk factors for sepsis, which would provide guidance for clinical diagnosis and treatment. Methods A total of 122 patients with LA treated in Peking University People's Hospital from 1 January 2016 to 31 October 2022 were recruited. Among the cases, 35 patients had sepsis (sepsis group) while the remaining 87 did not have sepsis (non-sepsis group). Clinical data were collected for all enrolled cases. Univariate analysis was performed to identify potential predictors, which were tested in multivariable logistic analysis to pinpoint the independent risk factors for sepsis in LA patients; these findings were utilized to develop a prediction model. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the prediction model. Informed consent to participate was obtained from the patients or their relatives. Results The incidence of shivering in the sepsis group was significantly higher than that in the non-sepsis group (p < 0.05). Through the univariate analysis, it was found that the reduction in platelet count and prothrombin time activity and the elevation of glycosylated hemoglobin (HbAlc) and procalcitonin (PCT) were more significant in the sepsis group than in the non-sepsis group (p < 0.05). Multivariate logistic regression analysis revealed that PCT and HbAlc were independent risk predictors of sepsis in LA patients within the derivation cohort (p < 0.05). Conclusion Elevated levels of HbAlc and PCT were independent risk factors for sepsis associated with LA. Patients with LA exhibiting elevated PCT levels demonstrated a 21% increased susceptibility to sepsis, and those with elevated HbAlc levels showed a 38% heightened risk for sepsis.
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Affiliation(s)
- Kai Wang
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Jihong Zhu
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Yang Guo
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Weibo Gao
- Department of Emergency, Peking University People's Hospital, Beijing, China
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13
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Xie Y, Guo LY, Liu B, Hu HL, Hu B, Chen TM, Qian SY, Hei MY, Liu G. Pyogenic liver abscess in pediatric populations in beijing (2008-2023). BMC Infect Dis 2024; 24:745. [PMID: 39075343 PMCID: PMC11285452 DOI: 10.1186/s12879-024-09634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Data on pyogenic liver abscess (PLA) of children in China have been limited. We aimed to summarize the clinical feather, microbiological characteristics, management, and outcome of PLA in children. METHOD We retrospectively reviewed PLA cases from January 2008 to June 2023 at Beijing Children's Hospital. Clinical characteristics, pathogens and management were analyzed. RESULTS We diagnosed 57 PLA patients in our center. The median onset age was 4.5 years and the male-to-female ratio was 1.6:1. The median diagnostic time was nine days and the median length of stay was 22 days. Twenty-eight patients (49.1%) had predisposing factors, around 71.4% of the patients had malignant hematology and primary immunodeficiency disease. Patients with underlying factors were more likely to have extrahepatic organ involvement (p = 0.024), anemia (p < 0.001), single abscess (p = 0.042), unilateral involvement (p = 0.039), and small size of the abscess (p = 0.008). Twenty-four patients (42.1%) had extrahepatic organ involvement. Pathogens were identified in 17 patients (29.8%), the most common pathogens were Klebsiella pneumoniae and Staphylococcus aureus. The positive rate of metagenomic next-generation sequencing (mNGS) was 87.5% (7/8). On multivariable analysis, the extrahepatic organ involved (p = 0.029) and hepatomegaly (p = 0.025) were two independent factors associated with poor outcomes. CONCLUSIONS PLA is usually seen in children with predisposing factors. Malignant hematology and primary immunodeficiency disease were the most common underlying diseases. Extrahepatic organ involvement and hepatomegaly are associated with poor prognosis. Increased use of mNGS could be beneficial for identifying pathogens.
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Affiliation(s)
- Yue Xie
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ling-Yun Guo
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Bing Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hui-Li Hu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Bing Hu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tian-Ming Chen
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Su-Yun Qian
- Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ming-Yan Hei
- Neonatal Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
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14
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Wendt S, Bačák M, Petroff D, Lippmann N, Blank V, Seehofer D, Zimmermann L, Lübbert C, Karlas T. Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital. Sci Rep 2024; 14:12972. [PMID: 38839980 PMCID: PMC11153614 DOI: 10.1038/s41598-024-63819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.
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Affiliation(s)
- Sebastian Wendt
- Hospital Hygiene Staff Unit, University Hospital Halle (Saale), Halle (Saale), Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | - Miroslav Bačák
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
- Institute for Medical Microbiology and Virology, Leipzig University Medical Center, Leipzig, Germany
| | - Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Medicine I, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Lisa Zimmermann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
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15
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Liu S, Ge X, Xu X, Zhang K, Lu X. Alterations of Gut Microbiota in Pyogenic Liver Abscess Patients with and without Type 2 Diabetes Mellitus. Infect Drug Resist 2024; 17:2149-2158. [PMID: 38828371 PMCID: PMC11144416 DOI: 10.2147/idr.s456423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose The clinical manifestations of pyogenic liver abscess (PLA) vary between patients with and without diabetes mellitus (DM). However, the relationship between PLA and the gut microbiome remains unknown. This study analyzed the composition of gut microbiota in PLA patients with and without DM and healthy controls (HCs) with the goal of identifying potential reasons for the observed variations in clinical manifestations. Patients and Methods Using 16S ribosomal RNA(16S rRNA) gene sequencing, we analyzed the compositions of gut microbiota in 32 PLA patients with DM, 32 PLA patients without DM, and 29 matched HCs. Results In PLA patients with DM, the D-dimer level, fibrinogen degradation products, and thrombin time were significantly higher compared to the PLA patients without DM (P < 0.05). The abundance and diversity of intestinal flora were reduced in both groups of PLA patients compared with the HCs (P < 0.05). Specifically, the PLA patients with DM showed significant decreases in the relative abundances of Bacteroides, Blautia, Prevotella9, and Faecalibacterium, whereas Enterococcus and Escherichia-Shigella were relatively more abundant (P < 0.05). Compared to PLA patients without DM, those with DM had lower relative abundances of Lactobacillus and Klebsiella (P < 0.05) and showed different bacterial flora, including Anaerosporobacter and Megamonas. Conclusion PLA patients with DM exhibited more severe clinical manifestations of PLA compared to patients without DM. It is important to monitor blood coagulation in PLA patients with DM to prevent the development of thrombotic diseases. Additionally, PLA patients with DM exhibit distinct differences in the composition and diversity of their intestinal flora compared to both PLA patients without DM and HCs.
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Affiliation(s)
- Shanshan Liu
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Infection Management, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The First People’s Hospital of Lianyungang, Jiangsu, People’s Republic of China
| | - Xiaomeng Ge
- Microbial Resources and Big Data Center, Institute of Microbiology, Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Kang Zhang
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xinxin Lu
- Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
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16
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Xu Q, Liu C, Wu Z, Zhang S, Chen Z, Shi Y, Gu S. Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species. Heliyon 2024; 10:e29463. [PMID: 38638973 PMCID: PMC11024600 DOI: 10.1016/j.heliyon.2024.e29463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Background Pyogenic liver abscess (PLA) is a potentially life-threatening intra-abdominal infection. We compared the clinical features, treatments, and prognoses of patients who had Klebsiella pneumonia pyogenic liver abscess (KPPLA) and non-Klebsiella pneumonia pyogenic liver abscess (non-KPPLA). Methods A retrospective analysis was used to compare the medical records of KPPLA and non-KPPLA patients with positive pus cultures at a single hospital in China from January 2017 to December 2019. Results We examined 279 patients with definitively established PLA, 207 (74.2 %) with KPPLA, and 72 with non-KPPLA. The non-KPPLA group had a higher Charlson comorbidity index, longer hospital stay, longer duration of fever, and greater hospital costs. Multivariate analysis showed that alcohol intake (OR: 2.44, P = 0.048), cancer (OR: 4.80, P = 0.001), ICU admission (OR: 10.61, P = 0.026), resolution of fever OR: 1.04, P = 0.020), and a positive blood culture (OR: 2.87, P = 0.029) were independent predictors of primary treatment failure. Percutaneous needle aspiration (PNA) and pigtail catheter drainage (PCD) provided satisfactory outcomes, but PNA led to shorter hospital stays and reduced costs, especially in KPPLA patients whose abscesses were smaller than 10 cm. Conclusion KPPLA and non-KPPLA patients had some differences in comorbidities and treatment strategies, and non-KPPLA patients had a significantly worse prognosis.
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Affiliation(s)
- Qiaomai Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changhong Liu
- Department of Hepatology, The Fifth People's Hospital of Ganzhou, Ganzhou Institute of Hepatology, Ganzhou, China
| | - Zhengjie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shumeng Zhang
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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Liu J, Liu Y, Li C, Peng W, Jiang C, Peng S, Fu L. Characteristics of Klebsiella pneumoniae pyogenic liver abscess from 2010-2021 in a tertiary teaching hospital of South China. J Glob Antimicrob Resist 2024; 36:210-216. [PMID: 38154752 DOI: 10.1016/j.jgar.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES Pyogenic liver abscess (PLA) is a severe and potentially fatal infectious disease. Klebsiella pneumoniae (K. pneumoniae) is the predominant pathogen responsible for PLA. This study aims to investigate the clinical characteristics and prognostic factors of K. pneumoniae-induced pyogenic liver abscess (KP-PLA), particularly those caused by carbapenem-resistant K. pneumoniae (CRKP). METHODS Analyses were performed on PLA patients from January 2010 to December 2021, to investigate the differences of K. pneumoniae from other etiologically infected PLA patients. Univariate and multivariate logistic regression analyses were used to compare prognostic factors between patients with carbapenem-resistant K. pneumoniae PLA (CRKP-PLA) and patients with carbapenem-sensitive K. pneumoniae PLA. RESULTS Univariate analysis demonstrated a significant association between KP-PLA and factors including diabetes mellitus (P < 0.001), cholecystitis and cholelithiasis (P = 0.032), single abscess (P = 0.016), and abscesses with a diameter over 50 mm (P = 0.004). The CRKP group exhibited a higher prevalence of therapeutic interventions before K. pneumoniae infection, including abdominal surgery, mechanical ventilation, sputum suction, tracheal cannula, routine drainage of the abdominal cavity, and peripherally inserted central venous catheters (P < 0.05). Multivariate logistic regression analysis revealed that admission to the intensive care unit was an independent risk factor associated with CRKP-PLA (odds ratio 36; 95% confidence interval 1.77-731.56; P = 0.020). CONCLUSION The KP-PLA patients were significantly associated with diabetes and were more likely to have single abscesses larger than 50 mm. PLA patients with a history of admission to intensive care unit or invasive therapeutic procedures should be given special consideration if combined with CRKP infection.
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Affiliation(s)
- Jinqing Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunhui Li
- Centre for Healthcare-Associated Infection Control, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenting Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chuan Jiang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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18
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Hu D, Chen W, Wu J, Luo X, Yu L, Qu Y, Zhang X, Zhang J, Ma B. Coexistence of c-rmpA with p-rmpA and p-rmpA2 rather than excessive siderophores confers higher virulence in K1 Klebsiella pneumoniae. Pathology 2023; 55:1004-1012. [PMID: 37802741 DOI: 10.1016/j.pathol.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 10/08/2023]
Abstract
Pyogenic liver abscess (PLA), which is particularly endemic in East Asia, is a relatively common and fatal infectious disease. Over the last 30-40 years, Klebsiella pneumoniae has replaced Escherichia coli as the dominant and overwhelming pathogen. To investigate the survival advantage of serotype K1 K. pneumoniae, we determined sequence types (STs), serotypes, and 11 virulence genes (allS, entB, irp2, iroN, iucA, fimH, mrkD, p-rmpA2, c-rmpA, p-rmpA, and peg-344). Virulence genes c-rmpA, p-rmpA, and p-rmpA2 in K. pneumoniae NTUH-K2044, which all confer hypercapsule and consequent hypervirulence, were deleted individually, and the consequent effects were evaluated. The lethality of various K1 K. pneumoniae strains was compared by using the Galleria mellonella model. In total, 31 K1 K. pneumoniae strains causing PLA and 30 causing non-PLA were identified. A significantly higher rate of c-rmpA was presented in PLA-derived K. pneumoniae strains than in non-PLA-derived strains. Similar ST23 (which dominates K1 strains) and string test-positive rates were observed in the two groups. Deletion of c-rmpA, p-rmpA, and p-rmpA2 individually did not confer significant effects on morphologies, such as positive string test, hypercapsule, and growth speed. Δc-rmpA presented weaker expressions of p-rmpA/p-rmpA2 than NTUH-K2044 and showed a higher expression of manC than Δp-rmpA and Δp-rmpA2. Three rmpAs conferred more virulence than one or two rmpAs, which presented an equally lethal effect in K1 K. pneumoniae. Klebsiella pneumoniae strains (H19 and H34) with the same genetic backgrounds except for siderophores showed equal virulence, but were less virulent than strain NTUH-K2044. Thus, the coexistence of c-rmpA with p-rmpA and p-rmpA2 enhances the lethality of K1 K. pneumoniae strains and the development of PLA. Excessive siderophores are not vital for the hypervirulence of K1 K. pneumoniae strains, although K1 strains usually harbour them on a molecular basis.
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Affiliation(s)
- Dakang Hu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Wenjie Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinzuan Wu
- Department of Clinical Laboratory, Pingyang Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinhua Luo
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Lianhua Yu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Ying Qu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Xijiang Zhang
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jin Zhang
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China.
| | - Bin Ma
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia.
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19
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Michael N, Parascandola S, Saint-Laurent S, Brown C, Maddox J, Bradley M, Learn P, Gage M. Rare Hypermucoviscous Klebsiella pneumoniae Liver Abscess in an Active Duty Male Requiring Partial Liver Resection for Definitive Treatment. Mil Med 2023; 188:e3720-e3725. [PMID: 37099739 DOI: 10.1093/milmed/usad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
Antibiotics and drainage have largely replaced hepatic resection for the treatment of liver abscesses in the modern era; however, in cases caused by a rare strain of Klebsiella pneumoniae with a hypermucoviscous phenotype, more aggressive hepatic resection may be required. The patient is a 34-year-old male who presented to Landstuhl Regional Medical Center with a week of epigastric pain. His workup revealed a 6 cm liver abscess with growth to 10 cm in 48 hours. He underwent multiple drainage procedures at Landstuhl and then was transferred to Walter Reed where further surgical drainage was performed. Initial cultures demonstrated K. pneumoniae. He clinically improved and was able to discharge after a 2 week hospitalization. His final remaining surgical drain was removed as an outpatient, but 48 hours after removal, he was admitted to the intensive care unit in septic shock. Imaging revealed a 12 cm liver abscess, and cultures verified hypermucoviscous Klebsiella. After multidisciplinary discussion and counseling, he underwent an open right partial hepatectomy. Postoperatively he gradually recovered from his sepsis and major operation and then returned to his home in Landstuhl. This is a case of a rare hypermucoviscous variant of K. pneumoniae causing a liver abscess resistant to multiple drainage procedures, ultimately requiring open hepatic surgical resection for source control. This remains a last-resort option in the treatment of liver abscesses and should be considered early when caused by this rare strain of Klebsiella.
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Affiliation(s)
- Nicholas Michael
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Salvatore Parascandola
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Stephanie Saint-Laurent
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Colin Brown
- Landstuhl Regional Medical Center, Landstuhl/Kirchberg, Rhineland-Pfalz 66849, Germany
| | - John Maddox
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Matthew Bradley
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Peter Learn
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Michele Gage
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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20
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Kimseng H, Rossi G, Danjean M, Jimenez-Araya B, Chaligne C, Galy A, Souhail B, Bert F, Leflon V, Fihman V, Caillault A, Demontant V, Seng S, Trawinski E, N 'Debi M, Boizeau L, Jacquier H, Ronot M, Reizine E, Le Roy V, Lefort A, Rodriguez C, Lepeule R, Woerther PL. Evaluation of the contribution of shotgun metagenomics in the microbiological diagnosis of liver abscesses. J Infect 2023; 87:365-372. [PMID: 37604210 DOI: 10.1016/j.jinf.2023.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Shotgun metagenomics (SMg) sequencing has gained a considerable interest, as it enables the detection of any microorganisms through a single analysis. Due to the limitations of standard microbiological approaches, the microbial documentation of liver abscesses (LA), which is crucial for their medical management, can be difficult. Here we aimed to compare the performance of SMg with standard approaches for the microbiological documentation of LA. METHODS In this retrospective study conducted at two centers, we compared the results of standard microbiology with metagenomics analysis of consecutive LA samples. For samples tested positive for Klebsiella pneumoniae, we compared the analysis of virulence and resistance genes using metagenomics data to whole-genome sequencing of corresponding isolates obtained in culture. RESULTS Out of the 62 samples included, standard approaches and SMg yielded documentation in 80.6% and 96.8%, respectively. In 37.1% (23/62) of cases, both methods showed identical results, whereas in 43.5% (27/62) of cases, the samples were positive by both methods, but SMg found additional species in 88.9% (24/27), mostly anaerobes. When the standard approaches were negative, the SMg was able to detect microorganisms in 80.0% of cases (8/10). Overall, SMg identified significantly more microorganisms than culture (414 vs.105; p<0.05). K. pneumoniae genome analysis was able to detect resistance and virulence genes with a level of sensitivity depending on the depth of sequencing. DISCUSSION Overall, we showed that SMg had better performance in detecting and identifying microorganisms from LA samples and could help characterizing strain's resistome and virulome. Although still costly and requiring specific skills and expensive equipment, MGs methods are set to expand in the future.
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Affiliation(s)
- Hadrien Kimseng
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Geoffrey Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Maxime Danjean
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Bryan Jimenez-Araya
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Camille Chaligne
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Adrien Galy
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; Antimicrobial Stewardship Team, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France
| | - Bérénice Souhail
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; Antimicrobial Stewardship Team, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France
| | - Frédéric Bert
- Department of Microbiology, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Véronique Leflon
- Department of Microbiology, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Vincent Fihman
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | | | | | - Sarah Seng
- NGS Platform, IMRB Institute, Créteil, France
| | | | | | | | - Hervé Jacquier
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Edouard Reizine
- Department of Radiology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Vincent Le Roy
- Department of Hepatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Agnès Lefort
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France; IAME, UMR1137, Université Paris-Cité, Paris, France
| | - Christophe Rodriguez
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; INSERM U955, IMRB Institute, Créteil, France; NGS Platform, IMRB Institute, Créteil, France
| | - Raphaël Lepeule
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; Antimicrobial Stewardship Team, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France
| | - Paul-Louis Woerther
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; NGS Platform, IMRB Institute, Créteil, France.
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21
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Kim SW, Jang BK. Toxocara canis and Fasciola hepatica Co-Infection Leading to Hepatic Abscess: A Case Report. J Korean Med Sci 2023; 38:e323. [PMID: 37821089 PMCID: PMC10562180 DOI: 10.3346/jkms.2023.38.e323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
Toxocariasis is a zoonotic disease caused by ingesting eggs from soil contaminated with Toxocara canis and Toxocara cati, commonly found in feces of infected dogs and cats, leading to a range of clinical symptoms including fever, abdominal pain and gastrointestinal manifestations. Fascioliasis is also a zoonotic disease caused by liver flukes Fasciola hepatica and Fasciola gigantica, which can be contracted through consumption of contaminated water or aquatic plants, leading to various clinical features. Here, we report a case of a 39-year-old woman diagnosed with a liver abscess caused by co-infection of T. canis and F. hepatica, as confirmed by serological tests. Although the existence of a pet dog and an experience of eating raw water dropwort are potential clues for diagnosis, it cannot be determined as the source of infection because the source of infection has not been clearly identified. After administrating albendazole and triclabendazole sequentially, the patient showed improvement in blood test and imaging findings. Clinicians should be aware of parasitic co-infection and take appropriate management.
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Affiliation(s)
- Seung Wan Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byoung Kuk Jang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
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22
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Bläckberg A, Jönsson A, Svensson E, Sunnerhagen T, Kiasat A, Ljungquist O. A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess. Open Forum Infect Dis 2023; 10:ofad352. [PMID: 37547858 PMCID: PMC10400158 DOI: 10.1093/ofid/ofad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/08/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pyogenic liver abscess (PLA) is a rare entity that is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (odds ratio [OR], 2.0 [95% confidence interval {CI}, 1.1-3.9]), malignancy (OR, 3.7 [95% CI, 1.9-7.1]), liver failure (OR, 6.3 [95% CI, 2.7-14.5]), and polymicrobial findings (OR, 3.8 [95% CI, 2.2-6.9]) were associated with death within 90 days (P < .05). Male sex (OR, 2.1 [95% CI, 1.2-3.6]), malignancy (OR, 2.1 [95% CI, 1.3-3.6]), age (64-74 years: OR, 2.5 [95% CI, 1.3-4.8]), and chronic liver disease (OR, 3.0 [95% CI, 1.4-6.5]) were associated with the risk of subsequent PLA (P ≤ .01). Conclusions Identifying different clinical variables associated with an unfavorable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.
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Affiliation(s)
- Anna Bläckberg
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
| | - Astrid Jönsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Lund, Sweden
| | - Ali Kiasat
- Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Ljungquist
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
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23
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Cui J, Liu Y, Li J. The New Changes of Epidemiology, Etiology, and Clinical Characteristics of Pyogenic Liver Abscesses: A Retrospective Study in a Hospital in Northern China. Infect Drug Resist 2023; 16:4013-4023. [PMID: 37377730 PMCID: PMC10292621 DOI: 10.2147/idr.s416860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose To investigate the epidemiology, etiology, and clinical characteristics of patients with pyogenic liver abscesses (PLA) and provide guidance for clinical treatments. Patients and Methods A retrospective study was performed on a cohort of 402 hospitalized patients diagnosed with PLAs at the Affiliated Hospital of Chengde Medical College between January 2016 and December 2021. Patient demographics, drug sensitivity profiles, and microbiological culture results of drainage and blood samples were thoroughly analyzed to identify significant patterns or trends. Furthermore, clinical characteristics and treatments for patients with PLA were comprehensively assessed. Results Patients aged 50-69 years had the highest incidence of PLA, accounting for 59.9% of all cases, and 91.5% of them had a fever. Bacterial culture analysis of the 200 patients revealed that Klebsiella pneumoniae (K. pneumoniae) was the most predominant pathogen, detected in 70.5% of cases, exhibiting an upward trend. Escherichia coli (E. coli) was the second most frequently detected pathogen, identified in 14.5% of cases, showing a downward trend. Coexisting diabetes mellitus (DM) was found to be the most common comorbidity for PLA, occurring in most patients with the condition. Patients with a history of abdominal surgery and malignancy had an increased risk for PLA, while those with gallstones had a decreased risk. Drainage combined with antibiotic therapy was identified as the primary treatment of PLA. In addition, multivariate analysis demonstrated that coexisting DM and the presence of gas in the abscess cavity were independent risk factors for septic shock in patients with PLA. Conclusion This study reveals a shift in the proportions of pathogens and risk factors in patients with PLA, underscoring the necessity for improved diagnostic and therapeutic strategies.
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Affiliation(s)
- JinHua Cui
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - YaMan Liu
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
| | - Jian Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde City, Hebei Province, People’s Republic of China
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24
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Guo M, Zhou B. Clinical efficacy of ulinastatin in the treatment of unliquefied pyogenic liver abscess complicated by septic shock: A randomized controlled trial. Immun Inflamm Dis 2023; 11:e822. [PMID: 37102655 PMCID: PMC10108682 DOI: 10.1002/iid3.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION This study determined the therapeutic effect of ulinastatin (UTI) on unliquefied pyogenic liver abscesses complicated by septic shock (UPLA-SS). METHODS This was a randomized controlled trial involving patients with UPLA-SS who underwent treatment at our hospital between March 2018 and March 2022. The patients were randomly divided into control (n = 51) and study groups (n = 48). Both groups received routine treatment, but the study group received UTI (200,000 units q8h for >3 days). Differences in liver function, inflammatory indices, and effectiveness between the two groups were recorded. RESULTS Following treatment, the white blood cell count, and lactate, C-reactive protein, procalcitonin, tumor necrosis factor-α, and interleukin-6 levels were significantly decreased in all patients compared to the admission values (p < .05). The study group had a faster decline with respect to the above indices compared to the control group (p < .05). The study group length of intensive care unit stay, fever duration, and vasoactive drug maintenance time were all significantly shorter than the control group (p < .05). The total bilirubin, alanine aminotransferase, and aspartate aminotransferase levels were significantly lower in the study and control groups after treatment compared to before treatment (p < .05); however, the study group had a faster recovery of liver function than the control group (p < .05). The overall mortality rate was 14.14% (14/99); 10.41% of the study group patients died and 17.65% of the control group patients died, but there was no statistically significant difference between the two groups (p > .05). CONCLUSION UTI combined with conventional treatment significantly controlled the infection symptoms, improved organ function, and shortened the treatment time in patients with UPLA-SS.
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Affiliation(s)
- Mingfeng Guo
- Department of ICUThe Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuP. R. China
| | - Bing Zhou
- Department of Hepatobiliary SurgeryThe Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuP. R. China
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Svensson E, Jönsson A, Bläckberg A, Sunnerhagen T, Kiasat A, Ljungquist O. Increasing incidence of pyogenic liver abscess in Southern Sweden: a population-based study from 2011 to 2020. Infect Dis (Lond) 2023; 55:375-383. [PMID: 36943906 DOI: 10.1080/23744235.2023.2190813] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease, and estimates suggest a gradual increase in the incidence during the last decades. The primary aim of this study was to report the incidence, trend and aetiology of PLA during a decade in Southern Sweden. METHODS This was a population-based observational cohort study between 2011 and 2020 in Skåne, Southern Sweden. Data were retrieved from the Swedish National Board of Health and Welfare for all individuals diagnosed with liver abscess (K750) according to ICD-10 (International Statistical Classification of Diseases, 10th revision). RESULTS A total of 456 episodes of PLA occurred in 364 patients during the study period. The median age of the first PLA episode was 71 years (range 3-97) and 57% (n = 206) were men. The mean incidence of all patients was 3.4/100,000 person-years (range 1.8-5.2). The incidence increased almost three times, from 1.8/100,000 person-years in 2011 to 5.2/100,000 person-years in 2020. Streptococcus species, Escherichia coli and Klebsiella species accounted for the vast majority of both mono- and polymicrobial findings in both blood and local abscess cultures. 16s rDNA added information about aetiology in 37% of episodes. CONCLUSION The incidence of PLA increased during the study period, and Streptococcus spp., Klebsiella spp. and E. coli dominated both blood and local cultures. Despite antimicrobial therapy, pathogens could be found in local abscess cultures several weeks into treatment. Increased use of 16s rDNA in the management of PLA could be beneficial.
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Affiliation(s)
- Emma Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Astrid Jönsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Bläckberg
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Ali Kiasat
- Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Ljungquist
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
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26
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Liu Y, Liu J, Fu L, Jiang C, Peng S. Demographics and Clinical Outcomes of Culture-Positive versus Culture-Negative Pyogenic Liver Abscess in an Asian Population. Infect Drug Resist 2023; 16:903-911. [PMID: 36814829 PMCID: PMC9940495 DOI: 10.2147/idr.s395428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
Objective Despite its high case-fatality risk, pyogenic liver abscess (PLA) lacks clear management guidelines in patients with negative microbial cultures. Our aim was to evaluate differences in clinical characteristics between patients with culture-negative liver abscess (CNLA) and those with culture-positive liver abscess (CPLA), and identify differences in the main causative pathogen. Methods In this study, we retrospectively collected medical records of PLA patients admitted to a teaching hospital from January 2010 to December 2019. Results In total, 324 PLA patients were enrolled in this study. Of these, 202 (62.3%) cases were confirmed cultural positive, including 109 patients (54%) and 20 (9.9%) patients infected with Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E.coli), respectively. Patients in the CPLA group were older (p=0.029) and had higher prevalence of abscesses larger than 5 cm in diameter (p = 0.003), gas-forming rate (p = 0.016), and percutaneous drainage (p < 0.001) compared with CNLA group. Patients with CPLA had significantly longer hospitalizations than those with CNLA (p = 0.010). Nevertheless, there was no significant difference in in-hospital mortality between the two groups (p = 0.415). Compared with patients with E. coli, those with K. pneumoniae had higher incidence of diabetes mellitus (p = 0.041), solitary abscess (p < 0.001), localization in the right hepatic lobe (p = 0.033), abscess size larger than 5 cm (p < 0.001) and percutaneous drainage (p = 0.002), but mortality was not significantly different (p = 1.000). Conclusion No significant difference in in-hospital mortality was found between patients with CNLA and those with CPLA group. However, clinical characteristics and management were different between the main causative pathogens, including K. pneumoniae and E. coli.
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Affiliation(s)
- Yao Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Jinqing Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Chuan Jiang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Correspondence: Shifang Peng, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China, Email
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Zeng X, Luo H, Yang P. Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study. Medicine (Baltimore) 2022; 101:e31745. [PMID: 36397374 PMCID: PMC9666222 DOI: 10.1097/md.0000000000031745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Percutaneous catheter drainage is the first-line treatment for pyogenic liver abscess (PLA). Some patients need hepatectomy because of underling hepatobiliary pathology or unresponsiveness to nonoperative treatment, the traditional method is open hepatectomy (OH). Laparoscopic hepatectomy (LH) for PLA is rarely reported. The purpose of this study is to describe our experience of LH for treating PLA and to compare LH with OH. The medical records of patients who underwent LH for treating PLA were retrospectively analyzed, and the results were compared with those of patients with OH. From January 2015 to December 2021, 61 patients with PLA underwent hepatectomy, and 28 patients who underwent LH (LH group) were compared with 33 patients who underwent OH (OH group). There were no significant differences in the basic data between the 2 groups. Two patients in the LH group were converted to open surgery due to hemorrhage and dense perihepatic adhesions, there was no significant difference between the 2 groups in the operation time (186.2 ± 85.6 vs. 175.9 ± 76.7 minutes, P = .239), Institut Mutualiste Montsouris classification, extent of hepatectomy and drainage tube removal time, however, the blood loss (200.0 ± 100.5 vs. 470.9 ± 120.1 mL, P = .003), numerical rating scale (5.2 ± 1.8 vs. 9.1 ± 1.6, P = .042), the time to resume oral diet (12.3 ± 6.5 vs. 24.6 ± 10.2 hours, P = .005), the ambulant time (20.2 ± 7.3 vs. 40.2 ± 10.8 hours, P = .010), incidence of postoperative complications (14.3% vs.33.3%, P = .002), comprehensive complication index (46.2 vs. 60.6, P = .013), postoperative hospital stay (8.5 ± 7.3 vs. 13.5 ± 10.2 days, P = .025) in the LH group was significantly less than that in the OH group. Wit experience laparoscopic surgeons, treating PLA by LH is safe and feasible and compares favorably with OH.
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Affiliation(s)
- Xintao Zeng
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- * Correspondence: Pei Yang, Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China (e-mail: )
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Ko DG, Park JW, Kim JH, Jung JH, Kim HS, Suk KT, Jang MK, Park SH, Lee MS, Kim DJ, Kim SE. Platelet-to-White Blood Cell Ratio: A Feasible Biomarker for Pyogenic Liver Abscess. Diagnostics (Basel) 2022; 12:diagnostics12102556. [PMID: 36292245 PMCID: PMC9600737 DOI: 10.3390/diagnostics12102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
The platelet-to-white blood cell ratio (PWR) has been reported to predict the severity of patients with various diseases. However, no previous studies have assessed the use of the PWR as a prognostic marker for pyogenic liver abscesses (PLA). This observational retrospective study was performed between January 2008 and December 2017, including 833 patients with PLA from multiple centers. The enrolled patients, on average, had a PWR of 17.05, and 416 patients had a PWR lower than 17.05. A total of 260 patients (31.2%) with PLA showed complications of metastatic infection, pleural effusion and abscess rupture. A low PWR level was identified as a strong risk factor for metastatic infection and pleural effusion. The low PWR group also had a longer hospital stay. In the multivariate analysis, old age, anemia, albumin and CRP levels and unidentified pathogens were significant factors for low PWR levels. A low PWR, old age, male sex, abscess size, albumin, ALP and unidentified causative pathogens showed significant associations with a hospital stay longer than 28 days. As a result, PLA patients presenting with a low PWR were shown to have more complications and a poor prognosis. Considering its cost-effectiveness, PWR could be a novel biomarker used to predict a prognosis of PLA.
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Affiliation(s)
- Dong-Gyun Ko
- Department of Physiology, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Ji-Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Medical Center, 22, Gwanpyeong-ro 170 Beon-gil, Anyang-si 14068, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Jung-Hee Kim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital of Hallym University Medical Center, Hwaseong-si 18450, Korea
| | - Jang-Han Jung
- Department of Internal Medicine, Dongtan Sacred Heart Hospital of Hallym University Medical Center, Hwaseong-si 18450, Korea
| | - Hyoung-Su Kim
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, 18, Cheonho-daero 173-gil, Seoul 05355, Korea
| | - Ki-Tae Suk
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital of Hallym University Medical Center, 77, Chuncheon-si 24253, Korea
| | - Myoung-Kuk Jang
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, 18, Cheonho-daero 173-gil, Seoul 05355, Korea
| | - Sang-Hoon Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital of Hallym University Medical Center, 1, Singil-ro, Seoul 07441, Korea
| | - Myung-Seok Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital of Hallym University Medical Center, 1, Singil-ro, Seoul 07441, Korea
| | - Dong-Joon Kim
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital of Hallym University Medical Center, 77, Chuncheon-si 24253, Korea
| | - Sung-Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Medical Center, 22, Gwanpyeong-ro 170 Beon-gil, Anyang-si 14068, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Correspondence: ; Tel.: +82-31-380-3708
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A wide clinical spectrum of pulmonary affection in subjects with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA). J Infect Chemother 2022; 29:48-54. [PMID: 36130707 DOI: 10.1016/j.jiac.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Klebsiella pneumoniae is a major pathogen of bacterial liver abscess in Asia. Particularly, patients with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA) tend to have a higher risk of invasive infection and pulmonary is a common invasive infectious site, making it a global clinical crisis. Therefore, considerable attention should be focused on the early prediction and active treatment strategies of such patients. METHODS The clinical data of 127 CA-KPLA cases hospitalized from January 2017 to February 2022 were collected from a single center. Risk factors were analyzed by the use of univariable and multivariable analysis. Furthermore, independent risk factors of pulmonary affection were utilized to construct a predictive nomogram. RESULTS The incidence of pulmonary affection in KPLA patients was 57.5% (73/127) and the majority manifested as nodular lesions with cavities and pleural effusion in chest CT images. Based on the predictive nomogram, the SOFA score (>2) was defined as the most dominant independent risk factor for the occurrence of pulmonary affection, followed by the maximum diameter of liver abscess (>3 cm), multiple liver abscesses, bacteremia, and badly-controlled diabetes sequentially. The validation of this nomogram also demonstrated good discriminative ability and satisfactory consistency. Finally, early drainage of liver abscess, initial combinational antibiotics, and early Carbapenem-including antibiotic usage were established as favorable factors for therapy in pulmonary affected CA-KPLA patients. CONCLUSION This study provided an effective model for the early prediction of pulmonary affection in patients with CA-KPLA and some rational strategies for their early therapeutic remission.
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