1
|
A Multicenter Retrospective Study on Clinical Characteristics and Outcome of Pyogenic Liver Abscess Focusing Multidrug-Resistant Organisms. J Clin Med 2022; 11:jcm11041114. [PMID: 35207386 PMCID: PMC8874681 DOI: 10.3390/jcm11041114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
The emergence of multidrug-resistant organisms (MDROs) is a growing problem worldwide. However, little is known about the incidence, clinical features and outcomes of pyogenic liver abscesses (PLAs) caused by MDROs. A retrospective study of 833 patients with PLA admitted from 2008 to 2017 was performed. MDROs were found in 55 (6.6%) patients, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was the most common causative microorganism. To evaluate the clinical features of and risk factors for MDRO-induced PLAs, propensity score matching (PSM) was performed in a 1:3 ratio (55 patients with MDROs and 165 patients without MDROs). After PSM, previous hepatobiliary procedure, preadmission exposure to antibiotics and elevated alkaline phosphatase levels were independent risk factors for MDRO-induced PLA. Sixteen patients (7.3%) died during hospitalization. Admission to intensive care unit (ICU), inadequate initial antibiotic treatment and use of inotropic agents were factors predictive of mortality. Although the presence of MDROs was not associated with in-hospital mortality, inadequate initial antibiotic treatment was prescribed to a large portion of the patients with MDRO-induced PLAs. We conclude that initial empirical antibiotic therapy for PLA should be based on the possibility of infection with MDROs, and close monitoring is necessary for patients with risk factors for in-hospital mortality.
Collapse
|
2
|
Chan KS, Shelat V. Pyogenic Liver Abscess. THE IASGO TEXTBOOK OF MULTI-DISCIPLINARY MANAGEMENT OF HEPATO-PANCREATO-BILIARY DISEASES 2022:509-519. [DOI: 10.1007/978-981-19-0063-1_66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
|
3
|
Li S, Yu S, Peng M, Qin J, Xu C, Qian J, He M, Zhou P. Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases. BMC Infect Dis 2021; 21:597. [PMID: 34157983 PMCID: PMC8220709 DOI: 10.1186/s12879-021-06325-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background Klebsiella pneumoniae is a primary pathogen of pyogenic liver abscess (PLA). However, little data are available on combination with sepsis. In this study, we aimed to evaluate the clinical characteristics and prognostic differences of PLA patients with sepsis. Methods This retrospective cohort study was conducted to investigate 135 patients with confirmed Klebsiella pneumoniae-caused liver abscesses (KPLA) from a tertiary teaching hospital, from 2013 to 2019. The patients were divided into two groups, KPLA with sepsis and KPLA without sepsis. The demographic characteristics, clinical features as well as laboratory and microbiologic findings were analyzed. Results A total of 135 patients with KPLA were analyzed. The mean age of patients was 60.9 ± 12.7 years, and the percentage of men was 59.3%. Among them, 37/135 (27.4%) of patients had sepsis and the mortality rate was 1.5%. The most common symptom was fever (91.1%). KPLA patients with sepsis had a significantly higher proportion of frailty, diarrhea, fatty liver, chronic renal insufficiency, and hepatic dysfunction compared to KPLA patients without sepsis (p < 0.05). Antibiotic therapy and percutaneous drainage were most frequently therapeutic strategy. Furthermore, the incidences of sepsis shock and acute respiratory distress syndrome were higher in the sepsis group compared to the non-sepsis group. As for metastatic infections, the lung was the most common site. In addition, KPLA patients with sepsis showed respiratory symptoms in 11 patients, endophthalmitis in 4 patients, and meningitis in 1 patient. Conclusion Our findings emphasize that KPLA patients combined with or without sepsis have different clinical features, but KPLA patients with sepsis have higher rates of complications and metastatic infections. Taken together, further surveillance and control of septic spread is essential for KPLA patients.
Collapse
Affiliation(s)
- Shixiao Li
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Sufei Yu
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Minfei Peng
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Jiajia Qin
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Chunyan Xu
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Jiao Qian
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Minmin He
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang province, China
| | - Peng Zhou
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, No. 150, Ximen Road of Linhai, Taizhou, 317000, Zhejiang Province, China.
| |
Collapse
|
4
|
A retrospective study of pyogenic liver abscess caused primarily by Klebsiella pneumoniae vs. non-Klebsiella pneumoniae: CT and clinical differentiation. Abdom Radiol (NY) 2020; 45:2669-2679. [PMID: 31894381 DOI: 10.1007/s00261-019-02389-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The incidence of Klebsiella pneumoniae pyogenic liver abscesses (KP-PLA) is increasing. However, its diagnosis and treatment are often delayed, leading to complications. In this study, we aimed to retrospectively compare computed tomographic (CT) features of KP-PLAs with those of abscesses caused by other bacterial pathogens (non-KP-PLAS) and to further identify prognostic factors for PLA. METHODS Data of 219 study patients including clinical presentation, comorbid conditions, metastatic infection, treatment duration, and mortality were retrospectively collated. CT characteristics of abscesses were recorded. Etiology was established by pus and/or blood culture. The differentiating CT features and clinical findings were compared between the monomicrobial KP-PLA and non-KP-PLA groups. Furthermore, factors related to in-hospital case fatality were analyzed. RESULTS Multivariate analysis identified thin-walled abscesses, absent rim enhancement, metastatic infection, and absence of underlying biliary tract disease as significant predictors of KP-PLA. With 3/4 criteria applied in combination, a specificity of 96.5% was achieved for KP-PLA diagnosis. The in-hospital mortality rate was 3.7%. Multivariate analysis revealed that diabetes mellitus (P = 0.031), multiple abscesses (P = 0.026), internal gas bubble (P = 0.041), metastatic infection (P = 0.004), and septic shock (P = 0.002) were significantly associated with mortality. CONCLUSION Thin-walled abscess, metastatic infection, absence of rim enhancement, and absence of underlying biliary tract disease are potentially useful CT findings for early KP-PLA diagnosis.
Collapse
|
5
|
He S, Yu J, Wang H, Chen X, He Z, Chen Y. Percutaneous fine-needle aspiration for pyogenic liver abscess (3-6 cm): a two-center retrospective study. BMC Infect Dis 2020; 20:516. [PMID: 32677915 PMCID: PMC7364546 DOI: 10.1186/s12879-020-05239-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter. The objective of this study was to evaluate the comparative effectiveness and safety of PNA combined with antibiotics. METHODS This was a retrospective study of patients with PLA that were from 3 to 6 cm in diameter who treated at two medical centers in Shanghai, China, from January 2014 to March 2019. Patients were divided into groups treated by PNA plus antibiotics or antibiotics alone. Patients demographics and clinical data related diagnosis, antibiotic treatment, and patient outcomes were analyzed. RESULTS Out of a total of 94 PLA patients, 42 (44.7%) patients received PNA combined with antibiotics, and 52 (55.3%) received antibiotics alone. There were no complications related to PNA. In the PNA group, 13 (31.7%) patients with negative blood culture and 8 (19.5%) patients without blood culture were microbiologically confirmed via aspiration. The time for temperature normalization (P < 0.001) and the reduction rate of C-reactive protein within the first week (P = 0.031) were significantly lower in the PNA group. In the multivariate analysis, treatment with PNA was more likely to result in clinical improvement of PLA (odds ratio = 0.33, 95% confidence intervals (CI): 0.11-0.96, P = 0.043). CONCLUSIONS PNA combined with antibiotics appears to be a safe, effective, and promising treatment for PLA of 3-6 cm in size. Furthermore, the technique allows for direct microbial sample, which can improve the selection of antibiotics.
Collapse
Affiliation(s)
- Shuangjun He
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Jie Yu
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Hairong Wang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Xinhua Hospital, Shanghai, China
| | - Xuelian Chen
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Zhanqiang He
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China
| | - Yi Chen
- Department of Emergency, South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai, 200025, China.
| |
Collapse
|
6
|
Park KS, Lee SH, Yun SJ, Ryu S, Kim K. Neutrophil-to-lymphocyte ratio as a feasible prognostic marker for pyogenic liver abscess in the emergency department. Eur J Trauma Emerg Surg 2018; 45:343-351. [PMID: 29480320 DOI: 10.1007/s00068-018-0925-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The neutrophil-to-lymphocyte ratio (NLR) is an effective predictor of mortality in patients with for various conditions. To date, there are no previous studies on NLR as a prognostic marker for pyogenic liver abscess (PLA), especially on admission to the emergency department (ED). METHODS From January 2013 to December 2015, 102 patients diagnosed with PLA in the ED were included. Clinico-radiological and laboratory results, including NLR, were evaluated as variables. NLR was calculated as absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of PLA, data on hospital mortality, intensive care unit (ICU) admission, and development of septic shock were obtained. Multivariate logistic regression analyses and receiver-operating characteristic (ROC) curve analysis were performed. RESULTS Among 102 patients, 10 (9.8%) died, 14 (13.7%) were admitted to the ICU, and 15 (14.7%) developed septic shock during hospitalization. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting death [odds ratio (OR), 1.4; p = 0.020], ICU admission (OR, 1.4; p = 0.021), and development of septic shock (OR, 1.6; p = 0.041). NLR showed an excellent predictive performance for death (areas under the ROC curves [AUC], 0.941; cut-off value, 19.7; p < 0.001), ICU admission (AUC, 0.946; cut-off value, 16.9; p < 0.001), and development of septic shock (AUC, 0.927; cut-off value, 16.9; p < 0.001). CONCLUSION NLR was positively associated with poor prognosis of PLA; elevated NLR could predictor of high risk of death, ICU admission, and development of septic shock. Emergency physicians should consider NLR for the prognosis of PLA and early aggressive treatment, especially in patients with NLR > 16.9.
Collapse
Affiliation(s)
- Kwang Soon Park
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-Gu, Seoul, 05278, Republic of Korea.
| | - Seokyong Ryu
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Keon Kim
- Department of Emergency Medicine, Ewha Womans University Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea
| |
Collapse
|
7
|
Mobasher-Jannat A, Akhavan-Moghadam J. Percutaneous drainage for giant pyogenic liver abscess-does size matter? Am J Surg 2016. [PMID: 28622835 DOI: 10.1016/j.amjsurg.2016.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
8
|
Cho AR, Lee TH, Park MJ, Oh SH, Lee JA, Park JH, Ryu KH, Koo HS, Song KH, Kim SM, Huh KC, Choi YW, Kang YW. Septic Shock in Pyogenic Liver Abscess: Clinical Considerations. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:245-52. [DOI: 10.4166/kjg.2016.67.5.245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Reum Cho
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Tae Hee Lee
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Min Ji Park
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Sun Hee Oh
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Joo Ah Lee
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Joo Ho Park
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Ki Hyun Ryu
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Hoon Sup Koo
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Ho Song
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Sun Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyu Chan Huh
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young Woo Choi
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young Woo Kang
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| |
Collapse
|
9
|
Kuo SH, Lee YT, Li CR, Tseng CJ, Chao WN, Wang PH, Wong RH, Chen CC, Chen SC, Lee MC. Mortality in Emergency Department Sepsis score as a prognostic indicator in patients with pyogenic liver abscess. Am J Emerg Med 2013; 31:916-21. [PMID: 23623237 DOI: 10.1016/j.ajem.2013.02.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The purpose of this study was to explore the predictor index of mortality in patients with pyogenic liver abscess (PLA). METHODS We performed a retrospective review that enrolled 431 patients 18 years and older hospitalized due to PLA between January 2005 and December 2010. Clinical characteristics, laboratory results, treatments, and outcomes retrieved from medical records were analyzed. Multiple logistic regression and receiver operating characteristic curve analyses were performed. RESULTS The mean age of the 431 patients identified with PLA was 56.9 ± 15.0 years. The mean Mortality in Emergency Department Sepsis (MEDS) score on admission was 4.8 ± 4.1 (range, 0-17). During hospitalization, 94 patients (22%) required intensive care. Of the 431 patients, 63 died, yielding a 15% case fatality rate. Multivariate analysis revealed that higher MEDS scores on admission (P < .0001) and the presence of underlying malignancy (P = .006), multiple abscesses (P = .001), anaerobic infections (P < .0001), hyperbilirubinemia (P < .0001), and higher serum creatinine levels (P < .0001) were significantly associated with PLA mortality. The estimated area under the receiver operating characteristic curve for MEDS in predicting PLA mortality was 0.829 (95% confidence interval, 0.791-0.864; P < .0001). The optimal cutoff MEDS value of 7 or higher had a sensitivity of 76% sensitivity and a specificity of 81%, with a 10.7-fold PLA mortality risk (P < .0001) and a 26.2-fold intensive care unit admission risk (P < .0001). CONCLUSIONS The MEDS scores on admission represent a significant prognostic indicator for patients with PLA.
Collapse
Affiliation(s)
- Sheng-Hung Kuo
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Are pyogenic liver abscesses still a surgical concern? A Western experience. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2012; 2012:316013. [PMID: 22536008 PMCID: PMC3296144 DOI: 10.1155/2012/316013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 12/25/2011] [Accepted: 12/30/2011] [Indexed: 01/03/2023]
Abstract
Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.
Collapse
|
11
|
Chen SC, Lee YT, Tsai SJ, Lai KC, Huang CC, Wang PH, Chen CC, Lee MC. Clinical outcomes and prognostic factors of cancer patients with pyogenic liver abscess. J Gastrointest Surg 2011; 15:2036-43. [PMID: 21826544 DOI: 10.1007/s11605-011-1650-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 07/26/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE Pyogenic liver abscess (PLA) of cancer patients often has a poor prognosis, but corresponding prognostic factors are less investigated. This study aimed to identify predictors of mortality in cancer patients with PLA. PATIENTS AND METHODS Medical records of 85 consecutive cancer patients (46 with hepatobiliary pancreatic cancer, 14 with gastrointestinal cancer, and 25 with non-digestive system cancer) having PLA who were admitted to two university hospitals were retrospectively reviewed. The predictors of mortality were determined using Cox regression model. RESULTS The overall case fatality rate was 33%. In multivariate analysis, the greater Acute Physiology and Chronic Health Evaluation II score (P = 0.028), multiloculated abscess (P = 0.025), and polymicrobial infection (P = 0.003) were associated with mortality. In subgroup analysis of the 25 patients with multiloculated abscess undergoing percutaneous catheter drainage as primary treatment, the case fatality rates of patients with a solitary smaller abscess (size < 5 cm), those with a solitary larger abscess (size > 5 cm), and those with larger multiple abscesses were 0%, 36%, and 85%, respectively (P = 0.002; using χ (2) for trend). CONCLUSIONS The advanced disease stage, multiloculated abscess, and polymicrobial infection posed a greater mortality risk in cancer patients with PLA. Moreover, an early surgical approach should be considered for cancer patients having large, multiloculated complex PLAs.
Collapse
Affiliation(s)
- Shiuan-Chih Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Liu KT, Lin TJ, Lee CW, Chen HC, Chang YY. Characteristics of undiagnosed liver abscesses on initial presentation at an emergency department. Kaohsiung J Med Sci 2010; 26:408-14. [PMID: 20705251 DOI: 10.1016/s1607-551x(10)70066-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 12/03/2009] [Indexed: 11/15/2022] Open
Abstract
Liver abscesses often present with nonspecific symptoms and laboratory examination abnormalities, resulting in missed diagnoses at emergency departments (ED). The purpose of this study was to determine if there are differences in presentation and prognosis between patients in whom liver abscess is diagnosed at an ED or once the patient has been transferred to a ward. Patients with a liver abscess who were discharged from our hospital between 2005 and 2007 were retrospectively reviewed. We compared the clinical characteristics between patients with liver abscess diagnosed at an ED or in a ward. Patients with liver abscess diagnosed at an ED had more abdominal pain (73.4%vs. 42.9%, p < 0.001), longer duration of symptoms before hospitalization (5.5 days vs. 3.8 days, p = 0.034) and fewer respiratory tract symptoms (12.5%vs. 24.5%, p = 0.05). Fewer cases with abnormal chest X-rays also existed for these patients (4.7%vs. 14.7%, p = 0.048). Cases not diagnosed at ED had delayed diagnoses for 4.41 +/- 3.16 days. Rates of mortality (6.3%vs. 8.2%, p = 0.740), shock (19.5%vs. 20.4%, p = 0.896), and length of hospital stay (19.6 days vs. 22.4 days, p = 0.173) were not significantly different between the patients diagnosed at an ED and those diagnosed later in a ward. Most information collected at the ED could not be used to aid diagnosis. Only abdominal pain was highly associated with liver abscess diagnosed at the ED. Undiagnosed liver abscess presented less abdominal pain and more symptoms or examination abnormalities related to infection of the respiratory and urinary tracts. Abdominal sonography should be performed more frequently at EDs to exclude liver abscess from differential diagnosis. However, further diagnosis and treatment while the patient with liver abscess is attending a ward does not affect prognosis.
Collapse
Affiliation(s)
- Kuan-Ting Liu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|
13
|
Simple Liver Cyst as a Focus of Salmonella paratyphi Abscess: A Case Report. J Trop Med 2009; 2009:456810. [PMID: 20309421 PMCID: PMC2836925 DOI: 10.1155/2009/456810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 11/03/2009] [Indexed: 11/17/2022] Open
Abstract
Salmonellosis, endemic in various part of the world, is considered a differential diagnosis in a tropical traveller. Although it usually presents as gastroenteritis, its various clinical syndromes may vary from mild gastroenteritis to severe septicaemia including abscess formation, the later two being the most common cause of morbidity and mortality. Here we present a patient who returned to the UK after an overseas trip and was diagnosed with a pyogenic liver abscess with Salmonella paratyphi at a site of a pre-existing simple liver cyst.
Collapse
|
14
|
Abstract
Increasing incidence and microbiologic shift might have changed the manifestation of this condition. Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a population-based study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance database and 506 cases from National Taiwan University Hospital. Our analysis showed that the annual incidence of pyogenic liver abscess increased steadily from 11.15/100,000 population in 1996 to 17.59/100,000 in 2004. Diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease. By contrast, death due to pyogenic liver abscess decreased over time, although population-based abscess-related death increased slightly. Renal disease, malignancy, pneumonia, and heart disease correlated with higher death rates; Klebsiellapneumoniae infection and therapeutic procedures were related to lower death rates. Diabetes did not significantly change death rates for the 506 patients from the hospital.
Collapse
|
15
|
Aggressive hepatic resection for patients with pyogenic liver abscess and APACHE II score > or =15. Am J Surg 2008; 196:346-50. [PMID: 18718219 DOI: 10.1016/j.amjsurg.2007.09.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 09/13/2007] [Accepted: 09/13/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most liver abscesses resolve after antimicrobial therapy or percutaneous tube drainage (PD). The aim of this study was to evaluate the results of hepatic resection (HR) for patients with pyogenic liver abscesses and an Acute Physiology and Chronic Health Evaluation II (APACHE II) score > or =15. METHODS We compared the clinical outcomes of 81 patients with APACHE II scores > or =15 undergoing PD and/or HR. RESULTS The failure rate (3 of 65) and double-treatment rate (32 of 65) in the PD group were significantly higher than in the HR group (3 of 35 vs 0 of 35; P = .0002). The mortality rate in the PD group was significantly higher than the other 2 groups (14 of 46 vs 2 of 19 and 1 of 16; P = .038). The length of hospital stay was significantly shorter and antibiotic use less in the HR group than in the PD group (P < .05). CONCLUSIONS Aggressive HR for patients with liver abscesses and APACHE II scores > or =15 produced better clinical outcomes.
Collapse
|
16
|
Cerwenka H. Is surgery still needed for the treatment of pyogenic liver abscess? Dig Liver Dis 2008; 40:697-8. [PMID: 18373965 DOI: 10.1016/j.dld.2008.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 01/31/2008] [Accepted: 02/02/2008] [Indexed: 12/11/2022]
Affiliation(s)
- H Cerwenka
- Department of Surgery, Medical University of Graz, A-8036 Graz, Austria.
| |
Collapse
|
17
|
Chen SC, Tsai SJ, Chen CH, Huang CC, Lin DB, Wang PH, Chen CC, Lee MC. Predictors of mortality in patients with pyogenic liver abscess. Neth J Med 2008; 198:164-72. [PMID: 18490797 DOI: 10.1016/j.amjsurg.2008.08.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 08/06/2008] [Accepted: 08/06/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is uncommon but potentially life-threatening. The objective of this study was to identify the prognostic factors for PLA. METHODS The medical records of 253 patients, 148 men and 105 women with a mean age of 56.4 years (SD : 15.0 years), who were hospitalised due to a PLA between January 1995 and June 2007 were reviewed. The underlying medical disorders, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatments, morbidity and mortality were recorded. Factors related to in-hospital case fatality were analysed. RESULTS The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at admission in patients with PLA was 8.7 points (SD 5.4 points). The most common co-existing disease was diabetes mellitus (41.9%), followed by biliary stone disorders (32.0%). Klebsiella pneumoniae was the most frequent pathogen, followed by Escherichia coli. The in-hospital case-fatality rate was 9.1%. Multivariate analysis revealed that gas-forming abscess (p=0.019), multi-drug resistant isolates (p=0.026), anaerobic infection (p=0.045), blood urea nitrogen level >7.86 mmol/l (p=0.004), and APACHE II score > or =15 (p= 0.004) were associated with mortality. CONCLUSIONS The prognosis of PLA may depend chiefly on the severity of the basic physical condition and underlying pathology. As the primary treatment for PLA is not completely effective, a more aggressive approach should be considered, especially for patients with poor prognosis.
Collapse
Affiliation(s)
- S C Chen
- Department of Family Medicine, Chung Shan Medical University, No.110, Sec.1, South District, Taichung City 40201, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Chen W, Chen CH, Chiu KL, Lai HC, Liao KF, Ho YJ, Hsu WH. Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care. Crit Care Med 2008; 36:1184-8. [PMID: 18379245 DOI: 10.1097/ccm.0b013e31816a0a06] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite improvements in diagnosis and treatment, pyogenic liver abscess remains a life-threatening disease. This study evaluated clinical outcome and prognostic factors in patients with pyogenic liver abscess admitted to the intensive care unit. DESIGN Retrospective study. SETTING Medical and surgical intensive care unit in a 1,700-bed university-based hospital. PATIENTS Four hundred and thirty-six adult patients (> or = 18 yrs) with a diagnosis of pyogenic liver abscess were reviewed, and 72 patients with pyogenic liver abscess who required intensive care were enrolled in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty of 72 enrolled patients died, yielding an intensive care unit mortality rate of 28%. The most common underlying disease was diabetes mellitus (51%), and the most common microorganism was Klebsiella pneumoniae (74%). Compared with survivors, nonsurvivors had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (22.2 +/- 9 vs. 13.7 +/- 6, p < .001), higher serum creatinine levels (2.9 +/- 2 vs. 1.9 +/- 2 mg/dL, p = .02), and longer prothrombin times (21 +/- 5 vs. 16 +/- 5 s, p = .01) on the first day of intensive care unit admission. In addition, factors associated with mortality included inadequate antibiotic therapy (p = .026), septic shock (p = .002), acute respiratory failure (p < .001), and acute renal failure (p = .043) on the first day of intensive care unit admission. On multivariate logistic regression analysis, factors that independently correlated with mortality were the presence of acute respiratory failure (p = .003, relative risk = 18.7) and APACHE II score > 16 (p = .026, relative risk = 7.43). CONCLUSIONS In patients with pyogenic liver abscess requiring intensive care, variables including size of liver abscess, pathogens, comorbidity, and most laboratory data were not associated with mortality. Only the presence of acute respiratory failure and APACHE II score >16 on the first day of intensive care unit admission were significant prognostic factors.
Collapse
Affiliation(s)
- Wei Chen
- Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | | | | | | | | | | |
Collapse
|