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Wu Z, Li J, Fang P, Pan C, Chen Y. Socioeconomic Burden of Pyogenic Liver Abscess Caused by Klebsiella Pneumoniae from a Teaching Hospital in East China. Infect Drug Resist 2024; 17:1589-1598. [PMID: 38681900 PMCID: PMC11055525 DOI: 10.2147/idr.s447506] [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: 11/21/2023] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Background The prevalence of pyogenic liver abscess (PLA) is increasing worldwide. However, evaluation on its economic burden is still lack. Methods A retrospective study that included all patients identified PLA from 2017 to 2020 was conducted. Clinical information and hospital costs were collected through the electronic medical records. We evaluated the economic burden using disability-adjusted life years (DALYs). Differences in socioeconomic burdens between Klebsiella pneumoniae-caused liver abscesses (KPLA) and non-Klebsiella pneumoniae-caused liver abscesses (non-KPLA) were compared. Results We found 327 patients identified PLA in the study, including 146 with KPLA and 181 with non-KPLA. The demographic characteristics, median hospital stay, severity, and in-hospital mortality were similar between the two groups. The median total in-hospital cost was higher in the non-KPLA than in the KPLA group, although no statistical difference was found ($3607.2 vs $3424.6; P = 0.446). The median DALY loss was significantly higher in the KPLA than in the non-KPLA group [1.49 (0.97-2.30) vs 1.27 (0.87-1.89); P = 0.033)], and male patients presented a higher average DALY loss than female patients. KPLA had a substantially greater median indirect economic loss than the non-KPLA group [$1442.8 (915.9-17,221.5) vs $1232.5 (764.6-15,473.0); P = 0.028], and indirect economic loss exhibited a significant increase from 2017 to 2020 in patients with PLA. No differences were found in the socioeconomic burden between the two groups [$8019.6 (4200.3-21,832.1) vs $7436.4 (4023.2-19,063.9); P = 0.172]. Conclusion The economic burden of PLA is significant, particularly in patients with KP. Patients with KPLA experienced increased DALY loss and indirect economic loss than non-KPLA. PLA must be prioritized as the indirect economic burden rises annually.
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Affiliation(s)
- Zhenzhu Wu
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, People’s Republic of China
| | - Jie Li
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, People’s Republic of China
| | - Peipei Fang
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, People’s Republic of China
| | - Chenwei Pan
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, People’s Republic of China
| | - Yi Chen
- Department of Gastroenterology, Wenzhou People’s Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
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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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Dong M, Ma X, Wang D, Ma X, Zhang J, Yu L, Yang Q, Hu D, Qiao D. Higher Virulence Renders K2 Klebsiella pneumoniae a Stable Share Among Those from Pyogenic Liver Abscess. Infect Drug Resist 2024; 17:283-291. [PMID: 38293315 PMCID: PMC10825582 DOI: 10.2147/idr.s442454] [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: 09/28/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
Objective To explore why serotype K2 accounts for a stable share in Klebsiella pneumoniae from pyogenic liver abscess (PLA). Methods Totally 15 K2 K. pneumoniae strains from PLA, 21 K2 from non-PLA, and 31 K1 from PLA were collected from China. Sequence typing, molecular serotyping, regular PCR, and Galleria mellonella lethality were performed. A total of 12 virulence genes were detected: peg-344, allS, p-rmpA, p-rmpA2, c-rmpA, fimH, mrkD, iucA, iroN, irp2, entB, and wzi. The differences between K2 K. pneumoniae strains from PLA and non-PLA were investigated along with K1 ones. Results Significant differences were found between K2 strains from PLA and non-PLA for the rates of virulence genes peg-344 and iucA. The latter group also showed more diverse sequence types than the former. Significant differences were only found for virulence genes allS and irp2 between K1 and K2 strains from PLA. Based on the equal virulence factors backgrounds other than serotypes, K2 strain is more virulent than K1 as G. mellonella lethality confirmed. Gene p-rmpA only brings equal virulence to p-rmpA plus p-rmpA2 in K2 strain. Conclusion Based on the same virulence factors backgrounds except serotypes, K2 K. pneumoniae is more virulent than K1 from PLA, which provides a survival advantage to maintain a stable share.
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Affiliation(s)
- Min Dong
- Department of Pulmonary Diseases (Department of Respiratory and Critical Care Medicine), Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, People’s Republic of China
| | - Xiumin Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Laboratory Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Donglian Wang
- Department of Laboratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, People’s Republic of China
| | - Xiaobo Ma
- Department of Clinical Laboratory, the First Affiliated Hospital of Xiamen University (Xiamen Key Laboratory of Genetic Testing), Xiamen, People’s Republic of China
| | - Jin Zhang
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Lianhua Yu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People’s Republic of China
| | - Qing Yang
- Department of Laboratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Dakang Hu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People’s Republic of China
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Dengyan Qiao
- Department of Laboratory Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, People’s Republic of China
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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: 1.0] [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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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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Iwadare T, Kimura T, Sugiura A, Takei R, Kamakura M, Wakabayashi SI, Okumura T, Hara D, Nakamura A, Umemura T. Pyogenic liver abscess associated with Klebsiella oxytoca: Mimicking invasive liver abscess syndrome. Heliyon 2023; 9:e21537. [PMID: 38027784 PMCID: PMC10660025 DOI: 10.1016/j.heliyon.2023.e21537] [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: 04/17/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
A pyogenic liver abscess (PLA) is a space-occupying lesion in the liver that is associated with significant morbidity and mortality. We herein present the case of a Japanese 76-year-old man who visited our hospital with fever and back pain lasting 3 weeks after endoscopic treatment for common bile duct stones. He was accompanied by poorly controlled diabetes mellitus (DM) with an HbA1c of 9.7 %. Laboratory tests disclosed elevated C-reactive protein level (22.1 mg/dL) and white cell count (11,910/μL). Abdominal computed tomography (CT) revealed hypodense lesions in the right liver lobe, with abdominal ultrasonography showing an echogenicity-mixed hypoechoic lesion. Percutaneous needle aspiration of a liver lesion was performed under suspicion of a PLA. Subsequent enhanced CT and magnetic resonance imaging confirmed the hepatic lesions in the right lobe as well as a septic pulmonary embolism, right hepatic vein thrombosis, spondylodiscitis, and a retroperitoneal abscess. Gram staining of the abscess drainage revealed gram-negative bacteria. The above findings indicated invasive liver abscess syndrome (ILAS) caused by Klebsiella pneumoniae. However, further examination of blood, urine, and abscess drainage cultures revealed positivity for Klebsiella oxytoca. This case illustrates that K. oxytoca may cause ILAS-like symptoms. Screening for systemic metastatic infection should be considered in patients with PLA due to K. oxytoca in whom therapeutic intervention has been delayed, especially in patients with poorly controlled DM.
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Affiliation(s)
- Takanobu Iwadare
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
| | - Ayumi Sugiura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Risa Takei
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masato Kamakura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shun-ichi Wakabayashi
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Taiki Okumura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daichi Hara
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Nakamura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
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Huang CY, Wu MY, Huang MC, Yu TS, Yen HR. The association between acupuncture therapy and the risk of reduced pressure ulcers in dementia patients: A retrospective matched cohort study. Integr Med Res 2023; 12:100981. [PMID: 37664454 PMCID: PMC10468362 DOI: 10.1016/j.imr.2023.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023] Open
Abstract
Background The pressure ulcer is a complication developed from dementia. The aim of this study is to study the association between the development of pressure ulcers and the use of acupuncture therapy in patients with dementia. Methods We performed a retrospective 1:1 propensity score-matched cohort study to investigate the association between acupuncture therapy and the risk of pressure ulcers in patients with dementia. Results A total of 8,994 patients were identified, 237 patients in the acupuncture cohort and 362 patients in the no-acupuncture cohort developed pressure ulcers. A reduced cumulative incidence of pressure ulcers was observed in the acupuncture cohort (P<0.001). The association between acupuncture and reducing the incidence of pressure ulcers was not affected by sex, age, residence, income, or comorbidities. The variables of etiologies to cause dementia did not change the final result. In the subgroups analyses, the patients without medication for dementia control had a significantly lower rate of pressure ulcers development when they had accepted acupuncture therapy (log-rank test, P<0.001). Conclusion Our results revealed the association between acupuncture therapy and a reduced incidence of pressure ulcer development in patients with dementia. This finding offers important ideas for further research.
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Affiliation(s)
- Chia-Yu Huang
- Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Mei-Yao Wu
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Cheng Huang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Rong Yen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- International Master Program in Acupuncture, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
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Li SZ, Liu SH, Hao M, Yu T, Hu S, Liu L, Liu ZL. Thrombocytopenia as an important determinant of poor prognosis in patients with pyogenic liver abscess: a retrospective case series. Front Surg 2023; 10:1192523. [PMID: 37560317 PMCID: PMC10407093 DOI: 10.3389/fsurg.2023.1192523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Thrombocytopenia and poor prognosis in severe conditions are associated. However, the clinical significance of thrombocytopenia in pyogenic liver abscess (PLA) has not been evaluated. OBJECTIVE To evaluate the association between thrombocytopenia and the prognosis of patients with PLA. METHODS A consecutive case series of 458 adult patients with PLA hospitalized at Tongji Hospital (Wuhan, China) between October 2011 and June 2021 was included in this cross-sectional analysis. Patient data were compared between the thrombocytopenia and non-thrombocytopenia groups. Multivariate logistic regression, receiver operating characteristic (ROC) curve and propensity score -matched analyses (PSM) were performed. RESULTS Of the 458 patients with PLA, 94 (20.5%) developed thrombocytopenia, 19 (4.1%) developed septic shock, 14 (3.1%) were admitted to the ICU, and 15 (3.3%) died during hospitalization. Thrombocytopenia was independently associated with shock (95%CI = 3.529-57.944, P < 0.001), ICU admission (95%CI = 1.286-25.733, P = 0.022), and mortality (95%CI = 1.947-34.223, P = 0.004) in multivariate regression analysis. ROC analysis showed that thrombocytopenia may be an identified marker of shock [area under the ROC curve (AUC), 0.8119; cut-off, 92.50; P < 0.0001], ICU admission (AUC, 0.7484; cut-off, 82.50; P < 0.0015), and mortality (AUC, 0.7827; cut-off, 122.50; P < 0.002). These findings remained consistent across 86 pairs of patients analyzed for PSM analyses. CONCLUSIONS Thrombocytopenia is an independent risk factor for poor prognosis in PLA and patients may be more prone to adverse outcomes.
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Affiliation(s)
- Sheng-zhong Li
- Department of Surgery, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shao-hua Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Meng Hao
- Department of Gastroenterology, Zigui County People’s Hospital, Yichang, China
| | - Tian Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Song Hu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Zhe-long Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
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Wang JL, Hsu CR, Wu CY, Lin HH. Diabetes and obesity and risk of pyogenic liver abscess. Sci Rep 2023; 13:7922. [PMID: 37193729 DOI: 10.1038/s41598-023-34889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
Few literatures discussed the relationship of glycemic control and body mass index (BMI) with the risk of pyogenic liver abscess. We conducted a population-based cohort study using participants of a community-based health screening program in Taiwan from 2005 to 2008 (n = 125,865). Information on fasting plasma glucose (FPG), BMI, and other potential risk factors of liver abscess were collected at baseline. Incidence of pyogenic liver abscess was ascertained using inpatient records from the National Health Insurance database. During a median 8.6 years of followed up, 192 incident cases of pyogenic liver abscess were reported. The incidence rate of pyogenic liver abscess was 70.2 and 14.7 per 100,000 in the diabetic and non-diabetic population respectively. In multivariable Cox regression analysis, the adjusted hazard ratio (HR) was 2.18 (95% confidence interval (CI) 1.22-3.90) in patients with diabetes with good glycemic control (FPG ≤ 130 mg/dl) and 3.34 (95% CI 2.37-4.72) in those with poor glycemic control (FPG > 130 mg/dl), when compared with non-diabetics. In the dose-response analysis, the risk of liver abscess increased monotonically with increasing FPG. After adjusting for diabetes and other comorbidities, overweight (25 ≤ BMI < 30) (adjusted HR: 1.43, 95% CI 1.05-1.95) and obese (BMI ≥ 30) (adjusted HR: 1.75, 95% CI 1.09-2.81) populations had a higher risk of liver abscess when compared to people with normal weight. Diabetes, especially poorly controlled disease, and high BMI were associated with higher risk of pyogenic liver abscess. Improving glycemic control and weight reduction may reduce the risk of developing pyogenic liver abscess.
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Affiliation(s)
- Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chun-Ru Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan
| | - Chieh-Yin Wu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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Jiménez-Romero C, Marcacuzco A, Caso Ó, Lechuga I, Manrique A, García-Sesma Á, Calvo J, Aguado JM, López-Medrano F, Juan RS, Justo I. Pyogenic liver abscesses in liver transplant recipients versus non-transplant population. Outcome and risk factors of patient survival. Clin Transplant 2023:e14966. [PMID: 36943872 DOI: 10.1111/ctr.14966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/10/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
Pyogenic liver abscess (PLA) is a life-threatening infection in both liver transplant (LT) and non-LT patients. Several risk factors, such as benign and malignant hepatopancreatobiliary diseases and colorectal tumors have been associated with PLA in the non-LT population, and hepatic artery stricture/thrombosis, biliary stricture, and hepaticojejunostomy in the LT patients. The objective of this study is to compare the outcomes of patients with PLA in LT and non-LT patients and to determine the risk factors associated with patient survival. From January 2000 to November 2020, a total of 296 adult patients were diagnosed of PLA in our institution, of whom 26 patients had previously undergone liver transplantation (LTA group), whereas 263 patients corresponded to the non-LTA population. Seven patients with PLA who had undergone previous kidney transplantation were excluded from this retrospective study. Twenty-six patients out of 1503 LT developed PLA (incidence of 1.7%). Median age was significantly higher in non-LTA patients (p = .001). No significant differences were observed in therapy. PLA recurrence was significantly higher in LTA than in non-LTA (34.6% vs. 14.8%; p = .008). In-hospital mortality was greater in the LT group than in the non-LT group (19.2% vs. 9.1% p = .10) and was identified in multivariable analysis as a risk factor for mortality (p = .027). Mortality rate during follow-up did not show significant differences between the groups: 34.6% in LTA patients versus 26.2% in non-LTA patients (p = .10). The most common causes of mortality during follow-up were malignancies, Covid-19 infection, and neurologic disease. 1-, 3-, and 5-year actuarial patient survival rates were 87.0%, 64.1%, and 50.4%, respectively, in patients of LTA group, and 84.5%, 66.5%, and 51.0%, respectively, in patients with liver abscesses in non-LTA population (p = .53). In conclusion, LT was a risk factor for in hospital mortality, but not during long-term follow-up.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alberto Marcacuzco
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Óscar Caso
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Isabel Lechuga
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alejandro Manrique
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Álvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Jorge Calvo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, "Doce de Octubre" Hospital, Research Institute (imas12), Faculty of Medicine, Complutense University, Complutense University, Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, "Doce de Octubre" Hospital, Research Institute (imas12), Faculty of Medicine, Complutense University, Complutense University, Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, "Doce de Octubre" Hospital, Research Institute (imas12), Faculty of Medicine, Complutense University, Complutense University, Madrid, Spain
| | - Iago Justo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
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11
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Pei N, Liu X, Jian Z, Yan Q, Liu Q, Kristiansen K, Li J, Liu W. Genome sequence and genomic analysis of liver abscess caused by hypervirulent Klebsiella pneumoniae. 3 Biotech 2023; 13:76. [PMID: 36748017 PMCID: PMC9898476 DOI: 10.1007/s13205-023-03458-6] [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: 04/26/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKp) is an important pathotype with enhanced virulence features compared with classical K. pneumoniae (cKp). hvKp usually causes life-threatening infections in the community, often affecting young and healthy individuals. During the past few decades, hvKp-induced liver abscess has been increasingly reported in Asia and is emerging as a global disease. To better comprehend the molecular characteristics of hvKp-induced liver abscess and recognize the global dissemination of hypervirulent strains with resistance determinants, we sequenced the whole genome of 26 K. pneumoniae strains from patients with liver abscess (KLA) and investigated the clinical factors related to different phenotype groups. The epidemiology, virulence-related factors, and antimicrobial resistance determinants were also discussed. The age, gender, and whether being hospitalized showed no differences among the string-positive and -negative groups were also studied. The assembly and annotation suggested that most of the 26 new liver abscess-causing hvKp strains were ST23-K1 or ST86-K2, and only one of the strains exhibited multidrug resistance. Compared with the existing 36 global liver abscess genome sequences, higher sequence type and virulence gene diversity were found in the new genomes. The clinical characteristics and genomic data of the isolated strains will enrich our knowledge for comparative genomic studies, allowing the better understanding of hvKp characteristics and evolution.
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Affiliation(s)
- Na Pei
- BGI-Shenzhen, Shenzhen, 518083 China.,Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Xin Liu
- BGI-Shenzhen, Shenzhen, 518083 China
| | - Zijuan Jian
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Qingxia Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Karsten Kristiansen
- BGI-Shenzhen, Shenzhen, 518083 China.,Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Junhua Li
- BGI-Shenzhen, Shenzhen, 518083 China.,Shenzhen Key Laboratory of Unknown Pathogen Identification, Shenzhen, 518083 China
| | - Wenen Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
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12
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Justo I, Vega V, Marcacuzco A, Caso Ó, García-Conde M, Manrique A, Calvo J, García-Sesma Á, San Juan R, Fernández-Ruiz M, Rivas C, Calero MR, Jiménez-Romero C. Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses. Langenbecks Arch Surg 2023; 408:97. [PMID: 36808482 PMCID: PMC9942623 DOI: 10.1007/s00423-023-02837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST. METHODS We reviewed the medical charts of all of our institution's adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST (n = 41 patients) and non-ST (n = 255). A comparison between groups was performed. RESULTS The overall median age was 68 years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10 days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group (p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST (p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10 days on presentation comprised the risk factors that indicated the need to perform ST. CONCLUSIONS There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10 days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD.
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Affiliation(s)
- Iago Justo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Viviana Vega
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Alberto Marcacuzco
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Óscar Caso
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - María García-Conde
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Alejandro Manrique
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Jorge Calvo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Álvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Rivas
- Department of Thoracic Surgery and Lung Transplantation, Madrid, Spain
| | - María Rosa Calero
- Department of Radiology, "Doce de Octubre" Hospital, Research Institute (imas12), Madrid, Spain
| | - Carlos Jiménez-Romero
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain.
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13
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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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14
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JinHua C, YaMan L, Jian L. Double pigtail tube drainage for large multiloculated pyogenic liver abscesses. Front Surg 2023; 9:1106348. [PMID: 36713673 PMCID: PMC9877412 DOI: 10.3389/fsurg.2022.1106348] [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: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study aims to investigate the efficacy and safety of double pigtail tube drainage compared with single pigtail tube drainage for the treatment of multiloculated pyogenic liver abscesses greater than 5 cm. Patients and Methods This study retrospectively analyzed patients with pyogenic liver abscess admitted in the Affiliated Hospital of Chengde Medical College between May 2013 and May 2021. Patients with pyogenic liver abscess more than 5 cm in size, who underwent drainage of the abscess with either double pigtail or single pigtail tube, were included. Results A total of 97 patients with pyogenic liver abscesses larger than 5 cm were studied. These included 34 patients with double pigtail tube drainage and 63 patients with single pigtail tube drainage. The postoperative hospital stay (13.39 ± 4.21 days vs. 15.67 ± 7.50 days; P = 0.045), and time for removal of the catheter (17.23 ± 3.70 days vs. 24.11 ± 5.83 days; P = 0.038) were lower in the double pigtail tube group compared with the single pigtail tube group. The rate of reduction, in three days, of c-reactive protein levels was 26.61 ± 14.11 mg/L/day in the double pigtail tube group vs. 20.06 ± 11.74 mg/L/day in the single pigtail tube group (P = 0.025). The diameter of the abscess cavity at discharge was 3.1 ± 0.07 cm in the double pigtail tube group as compared with 3.7 ± 0.6 cm in the single pigtail tube group (P = 0.047). There was no bleeding in any of the patients despite abnormal coagulation profiles. There was no recurrence of abscess within six months of discharge and no death in the double pigtail tube group. Conclusion: Double pigtail tube drainage treatment in multiloculated pyogenic liver abscesses greater than 5 cm in size, is safe and effective.
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Affiliation(s)
- Cui JinHua
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Liu YaMan
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Li Jian
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China,Correspondence: Li Jian
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15
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Chen Y, Lai X, Zhu Y, Wang M, He Y. Changes in clinical and CT manifestations related to liver abscesses in patients with vs. without basic diabetes mellitus before and after CT-guided interventional therapy: An observational study. Clinics (Sao Paulo) 2023; 78:100164. [PMID: 36657253 PMCID: PMC9868336 DOI: 10.1016/j.clinsp.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To explore differences in the changes of clinical and CT manifestations related to liver abscess before and after CT-guided interventional therapy between patients with and without Diabetes Mellitus (DM). MATERIALS AND METHODS Fifty-eight consecutive patients with liver abscesses were retrospectively enrolled in this study. All patients underwent upper abdominal contrast-enhanced CT scans before and after CT-guided interventional therapy. They were divided into two groups including the DM group (n=30) and the Non-DM group (n=28) if the liver abscess occurred in patients with and without DM, respectively. The changes in the clinical and CT manifestations related to liver abscess after CT-guided interventional therapy in both groups were statistically analyzed. RESULTS After CT-guided interventional therapy, the length of hospital stay, white blood cell recovery time and drainage tube removal time in the DM group were longer than in the Non-DM group (all p-values < 0.05). The incidence of postoperative complications in the DM group was higher than in the Non-DM group (p < 0.05). As shown on CT, the postoperative reduced percentage of maximum diameter of abscess cavity and the reduction rate of edema band surrounding the liver abscess in the DM group were smaller than in the Non-DM group (both p-values < 0.05). The time intervals of the previous characteristic changes on CT before and after interventional therapy in the DM group were longer than in the Non-DM group (all p-values < 0.05). CONCLUSIONS The liver abscesses patients with DM could not have a faster recovery and better therapeutic effect than those without DM after the CT-guided interventional therapy.
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Affiliation(s)
- Yuxiang Chen
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xunfu Lai
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yuping Zhu
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Mengting Wang
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yulin He
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China.
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16
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Tang L, Wang H, Cao K, Li Y, Li T, Huang Y, Xu Y. Epidemiological Features and Impact of High Glucose Level on Virulence Gene Expression and Serum Resistance of Klebsiella pneumoniae Causing Liver Abscess in Diabetic Patients. Infect Drug Resist 2023; 16:1221-1230. [PMID: 36879852 PMCID: PMC9985391 DOI: 10.2147/idr.s391349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/18/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacterium that is predominantly associated with liver abscesses in global diabetic patients. High levels of glucose in the surrounding of K. pneumonia increase its pathogenicity including capsular polysaccharide (CPS) and fimbriae. Other important virulent factors include outer membrane protein A (ompA) and regulator mucoid phenotype A (rmpA). The objective of this investigation was to elucidate the effects of high glucose on rmpA and ompA gene expression and serum resistance of K. pneumoniae causing liver abscess. Patients and Methods The clinical history of 57 patients suffering from K. pneumoniae-caused liver abscesses (KLA) was acquired and their clinical and laboratory manifestations in the presence or absence of diabetes were analyzed. The antimicrobial susceptibility, serotypes, and virulence genes were tested. Clinical isolates of 3 serotype-K1 hypervirulent K. pneumoniae (hvKP) were used to detect the effect of exogenous high glucose on rmpA, ompA, and clbB genes expression, and bacterial serum resistance. Results KLA patients with diabetes showed higher C-reactive protein (CRP) compared to non-diabetic KLA patients. Furthermore, the diabetic group showed increased incidences of sepsis and invasive infections, and their length of hospital stay was also prolonged. Pre-incubation of K. pneumoniae in high glucose (0.5%) concentration up-regulated rmpA, ompA, and clbB genes expression. However, cAMP supplementation, which was inhibited by environmental glucose, reversed the increase of rmpA and ompA in a cAMP-dependent manner. Moreover, hvKP strains incubated in high glucose also exhibited enhanced protection from serum killing. Conclusion High glucose levels reflected by poor glycemic control has increased gene expression of rmpA and ompA in hvKP by the cAMP signaling pathway and enhanced its resistance to serum killing, thus providing a new and reasonable explanation for the high incidences of sepsis and invasive infections in KLA patients with diabetes.
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Affiliation(s)
- Ling Tang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Hui Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Kangli Cao
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yajuan Li
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Tingting Li
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Ying Huang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yuanhong Xu
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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17
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Dai P, Hu D. The making of hypervirulent Klebsiella pneumoniae. J Clin Lab Anal 2022; 36:e24743. [PMID: 36347819 PMCID: PMC9757020 DOI: 10.1002/jcla.24743] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/01/2022] [Accepted: 10/09/2022] [Indexed: 10/08/2023] Open
Abstract
Klebsiella pneumoniae is a notorious bacterium in clinical practice. Virulence, carbapenem-resistance and their convergence among K. pneumoniae are extensively discussed in this article. Hypervirulent K. pneumoniae (HvKP) has spread from the Asian Pacific Rim to the world, inducing various invasive infections, such as pyogenic liver abscess, endophthalmitis, and meningitis. Furthermore, HvKP has acquired more and more drug resistance. Among multidrug-resistant HvKP, hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP), and carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP) are both devastating for their extreme drug resistance and virulence. The hypervirulence of HvKP is primarily attributed to hypercapsule, macromolecular exopolysaccharides, or excessive siderophores, although it has many other factors, for example, lipopolysaccharides, fimbriae, and porins. In contrast with classical determination of HvKP, that is, animal lethality test, molecular determination could be an optional and practical method after improvement. HvKP, including Hv-CRKP and CR-HvKP, has been progressing. R-M and CRISPR-Cas systems may play pivotal roles in such evolutions. Hv-CRKP and CR-HvKP, in particular the former, should be of severe concern due to their being more and more prevalent.
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Affiliation(s)
- Piaopiao Dai
- Department of Laboratory MedicineTaizhou Municipal HospitalTaizhouChina
| | - Dakang Hu
- Department of Laboratory MedicineTaizhou Municipal HospitalTaizhouChina
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18
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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: 2.0] [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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20
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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: 0] [Impact Index Per Article: 0] [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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Chen H, Fang L, Chen W, Yang Q, Li D, Hu D, Zhang J. Pyogenic liver abscess-caused Klebsiella pneumoniae in a tertiary hospital in China in 2017: implication of hypervirulent carbapenem-resistant strains. BMC Infect Dis 2022; 22:685. [PMID: 35945499 PMCID: PMC9361654 DOI: 10.1186/s12879-022-07648-0] [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: 01/13/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the epidemiology of Klebsiella pneumoniae (K. pneumoniae) inducing pyogenic liver abscess (PLA) in east China and the role of hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP). Methods Forty-three K. pneumoniae strains were collected from 43 patients with PLA at Hangzhou, China in 2017. Antimicrobial susceptibility tests, string test, multilocus sequence typing, pulsed-field gel electrophoresis, mobile genetic elements typing, regular PCR and sequencing, and Galleria mellonella (G. mellonella) lethality test were used to elucidate the epidemiology. Clinical data were collected. Results K. pneumoniae strains with serotypes K1 and K2 accounted for 69.8%, which shared 46.5% and 23.3% respectively. K. pneumoniae strains with clonal group 23 were predominant with a rate of 34.9%. Such antimicrobials showed susceptible rates over 80.0%: cefuroxime, cefotaxime, gentamycin, ticarcillin/clavulanate, ceftazidime, cefoperazone/tazobactam, cefepime, aztreonam, imipenem, meropenem, amikacin, tobramycin, ciprofloxacin, levofloxacin, doxycycline, minocycline, tigecycline, chloramphenicol, and trimethoprim-sulfamethoxazole. PFGE dendrogram showed 29 clusters for the 43 K. pneumoniae strains. Three Hv-CRKP strains were confirmed by G. mellonella lethality test, showing a constituent ratio of 7.0% (3/43). Totally three deaths were found, presenting a rate of 7.0% (3/43). The three died patients were all infected with Hv-CRKP. Conclusions K1 and K2 are the leading serotypes of K. pneumoniae causing PLA, which show highly divergent genetic backgrounds. Aminoglycosides, Generation 2nd to 4th cephalosporins, β-lactamase/β-lactamase inhibitors, carbapenems, fluoroquinolones are empirical choices. Hv-CRKP may confer an urgent challenge in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07648-0.
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Affiliation(s)
- Hongchao Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Lanfang Fang
- Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Wenjie Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Qing Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Dan Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Dakang Hu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, 318000, China.
| | - Jin Zhang
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, 318000, China.
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22
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Li S, Yu S, Qin J, Peng M, Qian J, Zhou P. Prognostic value of platelet count-related ratios on admission in patients with pyogenic liver abscess. BMC Infect Dis 2022; 22:636. [PMID: 35864446 PMCID: PMC9306147 DOI: 10.1186/s12879-022-07613-x] [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: 01/30/2022] [Accepted: 07/11/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE The purpose of the current study was to evaluate the association between C-reactive protein-to-platelet ratio (CPR), neutrophil-to-lymphocyte*platelet ratio (NLPR) and fibrinogen-to-platelet ratio (FPR) and the prognoses of pyogenic liver abscess (PLA) patients. METHODS A cohort of 372 patients with confirmed PLA were enrolled in this retrospective study between 2015 and 2021. Laboratory data were collected on admission within 24 h. The demographic characteristics and clinical features were recorded. Risk factors for outcomes of PLA patients were determined via multivariate logistic regression analyses, and optimal cut-off values were estimated by using the receiver operating characteristic (ROC) curve analysis. RESULTS Out of 372 patients, 57.8% were men, 80 (21.5%) developed sepsis, and 33 (8.9%) developed septic shock. The levels of CPR, NLPR and FPR were significantly increased in the development of sepsis, and prolonged hospital stays in PLA patients. The multivariate logistic regression analysis indicated that the CPR (OR: 2.262, 95% CI: 1.586-3.226, p < 0.001), NLPR (OR: 1.118, 95% CI: 1.070-1.167, p < 0.001) and FPR (OR: 1.197, 95% CI: 1.079-1.329, p = 0.001) were independent risks of PLA patients with sepsis, and NLPR (OR: 1.019, 95% CI: 1.004-1.046, p = 0.019) was shown to be an independent predictor of prolonged hospital stays. The ROC curve results showed that the three biomarkers had different predictive values, and CPR proved to work best, with a ROC value of 0.851 (95% CI: 0.807-0.896, p < 0.001) for sepsis. CONCLUSION Higher levels of CPR, NLPR and FPR were associated with a higher risk of poor outcomes. Moreover, a high CPR level performed best when predicting the clinical outcome in PLA patients.
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Affiliation(s)
- Shixiao Li
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Sufei Yu
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Jiajia Qin
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Minfei Peng
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Jiao Qian
- Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Peng Zhou
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150, Ximen Street, Taizhou, 317000, Zhejiang, China.
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23
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Hu D, Chen W, Zhang Q, Li M, Yang Z, Wang Y, Huang Y, Li G, Tian D, Fu P, Wang W, Ren P, Mu Q, Yu L, Jiang X. Prevalence of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae and Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae in China Determined via Mouse Lethality Tests. Front Cell Infect Microbiol 2022; 12:882210. [PMID: 35719357 PMCID: PMC9199425 DOI: 10.3389/fcimb.2022.882210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2023] Open
Abstract
Objective To investigate the epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP) and hypervirulent carbapenem-resistant Klebsiella pneumoniae (Hv-CRKP). Methods Totally 436 K. pneumoniae strains were collected from 7 hospitals in mainland China between 2017.01 and 2018.02. Sequence types, serotypes, antimicrobial-resistance and virulence genes were analyzed. Additionally, string test, capsule stain, Periodic Acid Schiff stain, fitness analysis, quantitative real-time PCR and mouse lethality test were also performed. Molecular combinations were used to screen putative blaKPC(+)-HvKP and Hv-blaKPC(+)-KP, followed by the confirmation of mouse lethality test. Results Diverse detection rates were found for the virulence genes, ranging from c-rmpA (0.0%) to entB (100.0%). According to the molecular criteria, 127, 186, 9 and 26 strains were putatively denoted as HvKP, blaKPC(+)-KP, blaKPC(+)-HvKP and Hv-blaKPC(+)-KP. Mouse lethality test confirmed 2 blaKPC(+)-HvKP strains (JS184 and TZ20) and no Hv-blaKPC(+)-KP. JS184 showed K2 serotype, thin capsule, positive exopolysaccharid and string test. TZ20 presented K20 serotype, thin capsule, negative exopolysaccharide and string test. Compared with the positive control NTUH-K2044, equal galF expression and growth curves were confirmed for JS184 and TZ20. Conclusions Molecular determination of CR-HvKP and Hv-CRKP brings remarkable bias compared with mouse lethality test. The exact prevalence of CR-HvKP is less than 1.0%, which of Hv-CRKP is much lower.
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Affiliation(s)
- Dakang Hu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Laboratory Medicine, Henan Provincial People’s Hospital & the People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zehua Yang
- Department of Laboratory Medicine, Sixth Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong Wang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yunkun Huang
- Department of Laboratory Medicine, Kunming Yan’an Hospital, Kunming, China
| | - Gang Li
- Department of Laboratory Medicine, Jinshan Hospital of Fudan University, Shanghai, China
| | - Dongxing Tian
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Pan Fu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Microbiology Department. Children’s Hospital of Fudan University, Shanghai, China
| | - Weiwen Wang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Ren
- Zhejiang Provincial Demonstration Centre of Laboratory Medicine Experimental Teaching, Wenzhou Medical University, Wenzhou, China
| | - Qing Mu
- School of Pharmacy, Fudan University, Shanghai, China
| | - Lianhua Yu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, China
- *Correspondence: Xiaofei Jiang, ; Lianhua Yu,
| | - Xiaofei Jiang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaofei Jiang, ; Lianhua Yu,
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24
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Chen G, Tuan S, Ou T. Unusual abdominal gas bubbles in a middle‐aged diabetic female. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Guan‐Bo Chen
- Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
| | - Sheng‐Hui Tuan
- Department of Rehabilitation Medicine Cishan Hospital, Ministry of Health and Welfare Kaohsiung Taiwan
- Department of Physical Therapy Shu‐Zen Junior College of Medicine and Management Kaohsiung Taiwan
| | - Tzu‐Ming Ou
- Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
- Division of Gastroenterology, Department of Internal Medicine Tri‐Service General Hospital, National Defense Medical Center Taipei Taiwan
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25
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The Incidence of Septic Pulmonary Embolism in Patients with Klebsiella pneumoniae Liver Abscess: A Systematic Review and Meta-analysis. Gastroenterol Res Pract 2022; 2022:3777122. [PMID: 35462985 PMCID: PMC9033355 DOI: 10.1155/2022/3777122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/23/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Septic pulmonary embolism (SPE) is an associated complication of Klebsiella pneumoniae liver abscess (KPLA). However, previous studies have reported that its incidence varies widely. We conducted a systematic review and meta-analysis to investigate the incidence of SPE in patients with KPLA. We further analyzed their clinical and computed tomography (CT) features. Methods: Two researchers reviewed PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify the articles that reported SPE in patients with KPLA. The search was conducted from the date of establishment of each database up to January 2021. After screening the articles and extracting the data, we used Review Manager 5.3 for analysis and processing. Results: We selected six articles that included 1,158 patients with KPLA. Of these, 70 patients had SPE. The pooled incidence of SPE was 6% (95% confidence interval, 3%–9%). Among patients with SPE, 85% were men, 72% had diabetes, and 52% displayed the feeding vessel sign on the chest CT. The mortality rate was 12%. Quality assessment revealed that half of the included studies had a high quality. Conclusion: The pooled incidence of SPE in patients with KPLA was 6%. Men and patients with diabetes were more prone to SPE. For patients with KPLA who had SPE as an associated complication, the mortality rate was approximately 12%.
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26
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Zhang J, Wang T, Fang Y, Wang M, Liu W, Zhao J, Wang B, Wu Z, Lv Y, Wu R. Clinical Significance of Serum Albumin/Globulin Ratio in Patients With Pyogenic Liver Abscess. Front Surg 2021; 8:677799. [PMID: 34917645 PMCID: PMC8669143 DOI: 10.3389/fsurg.2021.677799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022] Open
Abstract
Pyogenic liver abscess (PLA) remains a significant challenge for modern clinicians. Serum albumin/globulin ratio (AGR) can reflect the progress of many diseases. However, the clinical significance of AGR in PLA has not been evaluated. The aim of this study was to explore the effect of AGR on the clinical characteristic and prognosis in PLA patients. This retrospective study included 392 PLA patients who admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January, 2007 to December, 2016. The medical records on admission were collected. Compared with the healthy controls and the patients with extraperitoneal infection or non-infectious liver disease, PLA patients had lower levels of AGR. The mean level of AGR in PLA patients was 1.02 ± 0.25. There were 179 (45.4%) patients with AGR > 1.02 and 213 (54.6%) patients with AGR ≤ 1.02. The baseline data and treatment plans of PLA patients with high or low AGR were comparative. However, PLA patients with a low AGR had higher body temperature, leukocytes and neutrophils, lower hemoglobin, poorer liver and coagulation function, larger abscess diameter, higher positive rate of pus culture and proportion of Escherichia coli, and were more susceptible to multiple bacteria. Moreover, PLA patients with a low AGR had more complications, including systemic inflammatory response syndrome (SIRS), peritoneal effusion and pleural effusion. And it also needs longer time for temperature normalization and hospital stay. In conclusion, PLA patients have lower AGR and lower AGR is associated with worse clinical manifestations, more complications and poorer prognosis. Thus, monitoring of AGR is of great clinical significance for evaluating the progress of PLA patients.
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Affiliation(s)
- Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Fang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengzhou Wang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wuming Liu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junzhou Zhao
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Wang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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27
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Zhao ZH, Fan YC, Wang K. Pyogenic Liver Abscess Caused by Staphylococcus hominis: A Case Report. INFECTIOUS MICROBES AND DISEASES 2021; 4:79-81. [DOI: 10.1097/im9.0000000000000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
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28
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Kokayi A. Septic Shock Secondary to a Pyogenic Liver Abscess Following Complicated Appendicitis. Cureus 2021; 13:e18359. [PMID: 34725610 PMCID: PMC8553378 DOI: 10.7759/cureus.18359] [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] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
Pyogenic liver abscesses (PLAs) are a rare condition in North America and Europe and, rarer still, the cause of septic shock. This case report will describe the rare occurrence of a PLA producing septic shock in a 36-year-old male residing in the United Kingdom following a case of complicated appendicitis. The patient presented to the emergency department (ED) with a three-week history of intermittent loose stools, cramping abdominal pain, recurrent fevers, a heart rate of 111 beats per minute, a blood pressure of 94/58 mmHg, and a fever of 40.1 degrees Celsius. Despite prompt broad spectrum antibiotic administration and three liters of fluid resuscitation, the patient remained shocked which led to an ICU admission. A CT scan prior to transfer found a 7 cm x 6 cm x 6 cm lesion representing a liver abscess (LA) as well as gross inflammatory change affecting the distal small bowel. The LA was managed through insertion of a percutaneous drain under ultrasound guidance performed by the interventional radiology team, as well as ongoing IV antibiotics. Following growth of the gut commensal Streptococcus constellatus from the abscess fluid culture, a colonoscopy was performed which found a severely distorted and inflamed terminal ileum with an impassable stricture, raising not only the suspicion of appendicitis but also Crohn’s disease. Following the colonoscopy, after a total of 10 days admission, the patient was allowed to go home with a four-week course of oral co-amoxiclav. After discharge, the patient’s case was discussed in the gastroenterology inflammatory bowel disease (IBD) multi-disciplinary team meeting due to concerns raised about possible Crohn’s disease from the admission CT and following colonoscopy findings. Given the absence of relevant IBD symptoms, a reassuring outpatient MRI small bowel scan (found considerable resolution of the right iliac fossa inflammatory process) and a fecal calprotectin of 29 four months post discharge (normal=0-51 μg/g), it was concluded the terminal ileum changes were most likely accounted for by a complicated course of appendicitis. When reviewed in a telephone clinic 10 weeks post discharge, he was found to have no persistent gastrointestinal (GI) symptoms and was subsequently discharged. This case highlights the importance of comprehensive imaging and colonoscopy in the work up of those patients with PLAs with no otherwise evident precipitating factor.
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Affiliation(s)
- Adio Kokayi
- Intensive Care Unit, University College Hospital, London, GBR
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29
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Yoo JJ, Lee TK, Kyoung DS, Park MA, Kim SG, Kim YS. A population-based study of pyogenic liver abscess in Korea: Incidence, mortality and temporal trends during 2007-2017. Liver Int 2021; 41:2747-2758. [PMID: 34396681 DOI: 10.1111/liv.15034] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Although the epidemiology of pyogenic liver abscess (PLA) continues to change, only a few population-based studies have been conducted in Korea. This study investigated the epidemiology and clinical outcomes of PLA patients during a period of 10 years. METHODS We analysed the Health Insurance Review and Assessment Service data between 2007 and 2017. The data included annual incidence rates, demographic data, underlying diseases, complications and mortality of PLA patients. RESULTS The annual incidence of PLA for all age groups was 10.9 per 100 000 population. The incidence was gradually increased from 5.7 per 100 000 in 2007 to 14.4 per 100 000 in 2017. In patients with liver abscess, the prevalence of diabetes and malignancy were 37.24% and 26.5% respectively. Metastatic infection was reported in 1.74% of the patients, and endophthalmitis was most common. The mean in-hospital mortality was 9.6%, and there was no significant difference in mortality by year during the observation period. Mortality increased with age and was greatly affected by the underlying diseases, especially cancer. Based on the multivariate analysis results, the mortality of PLA patients was associated with older age, female sex, diabetes, malignancy and chronic kidney disease. CONCLUSION The PLA incidence is rapidly increasing in Korea, especially in people with comorbidities. In addition, the causes and risk factors of PLA infections are changing and thus further research on epidemiology, different diagnosis and management approaches is required.
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Affiliation(s)
- Jeong-Ju Yoo
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Tae Kyu Lee
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
| | | | - Min-Ae Park
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Sang Gyune Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Young Seok Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
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Shinmoto K, Hiraoka E, Horiuchi M, Sueda K, Oda R, Miyagaki A, Hoshina Y, Ehara J. Impact of antibiotic timing relative to percutaneous aspiration on culture positivity rate and clinical outcomes: A retrospective study of patients with pyogenic liver abscess. J Infect Chemother 2021; 28:336-338. [PMID: 34756828 DOI: 10.1016/j.jiac.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022]
Abstract
The optimal timing of antibiotic administration relative to liver abscess aspiration is debatable. This retrospective cohort study investigated whether the timing affects the abscess culture positivity rate and clinical outcomes. Twenty-nine patients with 30 percutaneously drained liver abscess cases were analyzed. Antibiotics were administered before aspiration (pre-aspiration antibiotics) in 22 cases and following aspiration (post-aspiration antibiotics) in 8 cases (i.e., 1 patient underwent aspiration twice, both before and following antibiotics). Both groups demonstrated similar patient characteristics, short time to aspiration, and high antibiotic appropriateness. Most patients were immunocompetent and non-septic. Pre-aspiration antibiotics did not reduce the culture yield (95% with pre-aspiration antibiotics vs. 100% with post-aspiration antibiotics; p = 1). Post-aspiration antibiotics were not associated with higher mortality, longer length of hospitalization, or an increased rate of clinical deterioration following aspiration. With appropriate antibiotic and aspiration, antibiotics timing can be either before or after aspiration without compromising the culture positivity rate and clinical outcomes.
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Affiliation(s)
- Keito Shinmoto
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan.
| | - Masao Horiuchi
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Keishiro Sueda
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Rentaro Oda
- Department of Infectious Diseases, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Aki Miyagaki
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yuiko Hoshina
- Department of Strategic Planning and Analysis, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Jun Ehara
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
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31
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Zheng Y, Ding Y, Xu M, Chen H, Zhang H, Liu Y, Shen W, Li J. Gut Microbiota Contributes to Host Defense Against Klebsiella pneumoniae-Induced Liver Abscess. J Inflamm Res 2021; 14:5215-5225. [PMID: 34675599 PMCID: PMC8519413 DOI: 10.2147/jir.s334581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/29/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Klebsiella pneumoniae-induced liver abscess (KLA) is a type of pyogenic liver abscess (PLA), which is a distinct invasive syndrome that has been increasingly reported worldwide over the past two decades. The intestinal microbiota is increasingly recognized as an important modulator that can promote and maintain host immune homeostasis. However, its precise role in liver abscess is unknown. We aimed to investigate the function of the gut microbiota in the host defense against K. pneumoniae infection. Methods We constructed C57BL/6J mice with KLA and analyzed the diversity and richness of the intestinal microflora by 16S rRNA sequencing. Next, to create a microbiota-depleted (MD) mouse model, we administered multiple broad-spectrum antibiotics and validated the model using 16S rRNA sequencing. At 48 h after K. pneumoniae infection, we assessed the general health condition, liver injury, bacterial loads, and inflammatory factor levels in MD+KLA mice. Additionally, fecal microbiota transplantation (FMT) was conducted in another group of MD+KLA mice prior to K. pneumoniae infection, and we assessed whether the transplantation changed the outcomes. Results The diversity of the intestinal flora was significantly changed in KLA mice compared to control mice, with a decrease in beneficial bacteria and an increase in harmful bacteria. The MD+KLA mice exhibited impaired antimicrobial capacity, reduced survival, increased inflammation and liver damage at 48 h after K. pneumoniae infection compared to the KLA mice. However, FMT normalized the inflammatory cytokine levels, reduced liver damage, and increased survival. Conclusion This study identified the gut microbiota as a protective factor against K. pneumoniae infection. The role of FMT in KLA should be investigated in future clinical studies.
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Affiliation(s)
- Yahong Zheng
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yuting Ding
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Mengran Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Haoran Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Hui Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yanyan Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People's Republic of China.,Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Weihua Shen
- Department of Special Clinic, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, Anhui, People's Republic of China.,Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People's Republic of China.,Department of Infectious Diseases, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Yu J, Ma J, Wang H, Shi Y, He S, Chen Y, Tang C. Clinical comparison of febrile and afebrile patients with pyogenic liver abscess: A two-centre retrospective study. Saudi J Gastroenterol 2021; 27:370-375. [PMID: 34657029 PMCID: PMC8656327 DOI: 10.4103/sjg.sjg_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND : Limited research has been conducted on afebrile pyogenic liver abscess (PLA). This poses a challenge in rapid diagnosis and early tailored care to physicians. In his study, we aimed to compare the clinical characteristics of afebrile and febrile patients with PLA. METHODS : We retrospectively analyzed the data of patients with PLA who were admitted to the emergency departments of two university hospitals between January 2014 and March 2020. Patients were classified into afebrile and febrile groups by using body temperature higher than 38°C as the reference standard. The demographic, clinical, and laboratory characteristics of both groups were compared. The primary outcome was all-cause in-hospital mortality and length of hospital stay. Multivariate analysis was performed to define factors associated with afebrile PLA. RESULTS : Of the 239 patients included in this study, 51 patients (21.3%) were afebrile and 188 patients (78.7%) were febrile. There were no differences between the abscess characteristics, laboratory manifestations, and disease severity of both groups; however, age and Charlson score differed between the groups (P = 0.009 and P = 0.011). The all-cause in-hospital mortality rate was much higher in the afebrile PLA group than in the febrile PLA group (9.8% vs. 2.1%, P = 0.011). Regarding the length of stay, no significant differences were noted in the febrile PLA group compared with the afebrile PLA group (18.5% vs 17.3%, P = 0.514). In multivariate analyses, only age greater than 65 years was significantly associated with afebrile PLA. CONCLUSIONS : Afebrile patients with PLA tend to be older, have higher Charlson scores, and in-hospital mortality rate than those with febrile patients. PLA patients older than 65 years are more likely to present without fever (<38°C) at the time of the emergency visit.
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Affiliation(s)
- Jie Yu
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Jun Ma
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Hairong Wang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Xinhua Hospital, Kongjiang Road, Yangpu District, Shanghai, China
| | - Yujun Shi
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Shuangjun He
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Yi Chen
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Chao Tang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China,Address for correspondence: Dr. Chao Tang, Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai - 200025, China. E-mail:
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Tebbe JJ, Kulamadayil-Heidenreich NSA, Heidenreich H, Bongartz HG, Tebbe S. Multidisciplinary out-patient treatment with monitoring by telemedicine for a large-volume multifocal pyogenic liver abscess in times of the pandemic. Clin Case Rep 2021; 9:e04970. [PMID: 34721853 PMCID: PMC8543053 DOI: 10.1002/ccr3.4970] [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: 08/12/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Pyogenic liver abscesses represent one of the rarer, but potentially life-threatening diseases of the liver. The treatment for large-volume liver abscesses is usually multimodal with percutaneous drainage combined with several days of treatment in hospital. We are presenting a report on a male patient with type-2 diabetes mellitus who suffered from a multifocal liver abscess (>10 cm). Due to the exceptional situation caused by the corona pandemic, the patient was treated conservatively with non-standard treatment which involved a multidisciplinary team and out-patient visits. Follow-up to ensure the treatment would be successful was carried through dialogue with the GP responsible for the patient's care, as well as daily telemedicine visits. The daily telemedicine visits were supplemented by episodic follow-up testing of laboratory values and contrast-enhanced ultrasound scans (CEUS) of the liver. We show that purely conservative therapy can be successful in a case with a high risk of mortality by using a combination of close telemedical monitoring and proactive interdisciplinary collaboration with the GP.
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Affiliation(s)
- Johannes J Tebbe
- Department of Gastroenterology and Infectious Disease University Hospital OWL Campus Lippe University of Bielefeld Bielefeld Germany
| | | | - Holger Heidenreich
- Department of Gastroenterology and Infectious Disease University Hospital OWL Campus Lippe University of Bielefeld Bielefeld Germany
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Losie JA, Lam JC, Gregson DB, Parkins MD. Epidemiology and risk factors for pyogenic liver abscess in the Calgary Health Zone revisited: a population-based study. BMC Infect Dis 2021; 21:939. [PMID: 34507537 PMCID: PMC8431851 DOI: 10.1186/s12879-021-06649-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/28/2021] [Indexed: 12/20/2022] Open
Abstract
Background Pyogenic liver abscess (PLA), although uncommon in North America, is associated with significant morbidity and mortality. We sought to re-examine the epidemiology, risk factors, and outcomes of PLA in a large, diverse Canadian health zone. Methods All Calgary Health Zone (CHZ) residents aged ≥20 with PLA between 2015 and 2017 were identified. Incidence and mortality rates were calculated using census data. Risk factors for PLA were identified using a multivariate analysis. Data was compared to 1999–2003 data, also collected in the CHZ. Results There were 136 patients diagnosed with PLA between 2015 and 2017. Incidence rate during this period increased significantly relative to 1999–2003 (3.7 vs 2.3 cases/100,000 population, p < 0.01), however, mortality rates remained similar. The microbiological composition of PLA did not change over this 15-year time period but the number of antimicrobial resistant isolates did increase (8% vs 1%, p = 0.04). The greatest risk factors for PLA relative to general populations included current malignancy, liver-transplant, end-stage renal disease, and cirrhosis. Thirty-day mortality was 7.4% and independent risk factors included polymicrobial bacteremia, absence of abscess drainage, congestive-heart failure, a history of liver disease, and admission bilirubin. Conclusions Pyogenic liver abscess is a health concern with rising incidence rate. The increasing prevalence of comorbidities in our population and factors that are associated with risk of PLA suggests this will continue to be an emerging diagnosis of concern. Increasing prevalence of antibiotic resistant organisms compounding unclear optimal treatment regimens is an issue that requires urgent study.
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Affiliation(s)
- Jennifer A Losie
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - John C Lam
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Daniel B Gregson
- Department of Medicine, University of Calgary, Calgary, Canada.,Alberta Provincial Laboratories, Calgary, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Michael D Parkins
- Department of Medicine, University of Calgary, Calgary, Canada. .,Department of Microbiology and Infectious Diseases, Calgary Zone Alberta Health Services, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Utility of Acute Physiology and Chronic Health Evaluation (APACHE II) in Predicting Mortality in Patients with Pyogenic Liver Abscess: A Retrospective Study. J Clin Med 2021; 10:jcm10122644. [PMID: 34208437 PMCID: PMC8235429 DOI: 10.3390/jcm10122644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 12/28/2022] Open
Abstract
Pyogenic liver abscess (PLA) is a major life-threatening disease with varied clinical features. This study aimed to determine predictors of mortality in patients with PLA using criteria determined upon admission. We retrospectively examined the data of 324 hospitalized adults in whom liver abscesses were confirmed using abdominal ultrasound and/or computed tomography. The relationship between various risk factors was assessed using multivariate analysis. A total of 109 (33.6%) patients were admitted to the intensive care unit (ICU). The overall mortality rate was 7.4% and was higher among ICU patients than non-ICU patients (21.1% vs. 0.5%, p < 0.001). PLA patients with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥18 had a 19.31-fold increased risk, and those with concomitant infections had a 34.33-fold increased risk of 30-day mortality according to multivariate analysis. The estimated area under the receiver operating characteristic curve for predicting 30-day mortality revealed that APACHE II score ≥18 (sensitivity of 75% and specificity of 84%, p < 0.0001) had better discriminative power than Sequential Organ Failure Assessment (SOFA) ≥6 (sensitivity of 81% and specificity of 66%, p < 0.0001). APACHE II has shown better discrimination ability than SOFA in predicting mortality in PLA patients. To improve outcomes in patients with PLA, future management strategies should focus on high-risk patients.
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Wang TY, Lai HC, Chen HH, Wang ML, Hsieh MC, Chang CT, Chen RH, Ho CW, Hung YC, Tseng JY, Lin CL, Kao CH. Pyogenic Liver Abscess Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Nationwide, Population-Based Cohort Study. Front Med (Lausanne) 2021; 8:675345. [PMID: 34055845 PMCID: PMC8149939 DOI: 10.3389/fmed.2021.675345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background: To date, no comprehensive epidemiological study exists on pyogenic liver abscess (PLA) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) worldwide. Methods: We conducted a retrospective cohort study by using data from Taiwan National Health Insurance Research Database (NHIRD) to examine the association between newly diagnosed T2DM and PLA. The T2DM cohort included patients newly diagnosed as having T2DM (ICD-9-CM:250) from 2000 to 2009, with follow-up until December 31, 2011. The comparison cohort was then recruited through 1:4 random frequency matching with the T2DM cohort. Finally, the adjusted hazard ratios for PLA were compared between the T2DM and comparison cohorts, which included 44,728 patients with T2DM and 178,912 patients without DM respectively. Results: In T2DM cohort, 166 patients were diagnosed as having PLA (incidence rate = 5.87 per 10,000 person-years) and in comparison cohort, 238 patients were diagnosed as having PLA (incidence rate = 2.06 per 10,000 person-years). The T2DM cohort exhibited higher PLA risk than did the comparison cohort (hazard ratio = 2.83, 95% confidence interval = 2.32-3.46). Furthermore, the adjusted hazard ratio for PLA risk in T2DM cohort was the highest in those who were younger, man and with duration of DM <2 years. In the T2DM cohort, the most common PLA causative agent was Klebsiella pneumonia (KP). In addition, PLA risk was high in T2DM patients with gallstone and cholecystitis. Compared with comparison cohort, patients with T2DM prescribed acarbose has a lower PLA risk, however glyburide significantly increased PLA risk in T2DM cohort. Conclusion: In patients with newly diagnosed T2DM, PLA risk was high and acarbose might reduce PLA risk.
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Affiliation(s)
- Tzu-Yuan Wang
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Hung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Chung Sheng Clinic, Nantou, Taiwan
| | - Mei-Lin Wang
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Ming-Chia Hsieh
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chwen-Tzuei Chang
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Rong-Hsing Chen
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Wei Ho
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Chin Hung
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Juei-Yu Tseng
- Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and Positron Emission Tomography (PET) Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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Yin D, Ji C, Zhang S, Wang J, Lu Z, Song X, Jiang H, Lau WY, Liu L. Clinical characteristics and management of 1572 patients with pyogenic liver abscess: A 12-year retrospective study. Liver Int 2021; 41:810-818. [PMID: 33314531 PMCID: PMC8048845 DOI: 10.1111/liv.14760] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Pyogenic liver abscesses (PLA) are space-occupying lesions in the liver that produce high morbidity and mortality. The clinical characteristics and prognosis of abscesses is different depending on the bacterial culture results and require different strategies for management. The aim of this study was to investigate the clinical characteristics and prognostic factors of patients with PLA. METHODS Clinical features, laboratory tests and etiology of PLA between 2006 to 2011 and 2012 to 2017 in a single hospital were retrospectively reviewed. The incidence and mortality of PLA caused by Escherichia coli and Klebsiella pneumoniae were compared and the risk factors for multiple organ dysfunction (MODS) and endophthalmitis were evaluated. RESULTS Among the 1,572 PLA patients, the proportion with PLA increased from 333 (21.2%) in 2006-2011 to 1,239 (78.8%) in 2012-2017 without any investigation and treatment procedure differences. K pneumoniae was the main isolate in analysed pus cultures (85.6%). The mortality rate of patients with K pneumoniae infection was lower in the latter period (6.7% vs 0.7%, P = .035). Multivariate analyses revealed that age, fever, MODS and length of hospital stay were factors affecting poor prognosis (death + unhealed/uncured) in PLA patients after treatment and that cardiovascular disease, pleural effusion and pulmonary infection were risk factors for MODS, while diabetes mellitus was the only risk factor for endophthalmitis. Most patients (95.5%) with PLA recovered after abscess drainage/puncture and antibiotic therapy. CONCLUSIONS Pleural effusion, fever, MODS and length of hospital stays were factors useful in predicting PLA outcomes.
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Affiliation(s)
- Dalong Yin
- Department of Hepatobiliary SurgeryThe First Affiliated HospitalDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Changyong Ji
- Department of Liver SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Shugeng Zhang
- Department of Hepatobiliary SurgeryThe First Affiliated HospitalDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina,Department of Liver SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Jiabei Wang
- Department of Hepatobiliary SurgeryThe First Affiliated HospitalDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Zhaoyang Lu
- Department of Liver SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Xuan Song
- Department of Liver SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Hongchi Jiang
- Department of Liver SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Wan Yee Lau
- Faculty of Medicinethe Chinese University of Hong KongHong Kong SARChina
| | - Lianxin Liu
- Department of Hepatobiliary SurgeryThe First Affiliated HospitalDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina,Department of Liver SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
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Lee CH, Jo HG, Cho EY, Song JS, Jung GM, Cho YK, Seo SY, Kim SH, Kim SW, Lee SO, Lee ST, Kim IH. Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess. BMC Infect Dis 2021; 21:171. [PMID: 33573593 PMCID: PMC7879520 DOI: 10.1186/s12879-021-05873-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background/aims This study aimed to investigate the factors associated with prolonged hospital stay and in-hospital mortality in patients with pyogenic liver abscess. Methods We retrospectively reviewed data from patients with pyogenic liver abscess who were admitted between 2005 and 2018 at three tertiary hospitals in Jeonbuk province, South Korea. Prolonged hospital stay was defined as a duration of hospital admission of more than 21 days. Results A total of 648 patients (406 men and 242 women) diagnosed with pyogenic liver abscess were enrolled in the study. The mean maximal diameter of the liver abscess was 5.4 ± 2.6 cm, and 74.9% of the lesions were single. The three groups were divided according to the maximal diameter of the abscess. Laboratory parameters indicated a more severe inflammatory state and higher incidence of complications and extrahepatic manifestations with increasing abscess size. Rates of percutaneous catheter drainage (PCD) insertion, multiple PCD drainage, and salvage procedures as well as duration of drainage were also higher in the large liver abscess group. Of note, the duration of hospitalization and in-hospital mortality were significantly higher in the large hepatic abscess group. A multivariate analysis revealed that underlying diabetes mellitus, hypoalbuminemia, high baseline high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and large maximal abscess diameter were independent factors associated with prolonged hospital stay. Regarding in-hospital mortality, acute kidney injury at admission and maximal diameter of the abscess were independent factors associated with in-hospital mortality. Conclusions A large maximal diameter of the liver abscess at admission indicated prolonged hospitalization and poor prognosis. More aggressive treatment strategies with careful monitoring are warranted in patients with large liver abscesses. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05873-7.
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Affiliation(s)
- Chang Hun Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea
| | - Hoon Gil Jo
- Division of Gastroenterology, Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, South Korea
| | - Eun Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, South Korea
| | - Jae Sun Song
- Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, South Korea
| | - Gum Mo Jung
- Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, South Korea
| | - Yong Keun Cho
- Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, South Korea
| | - Seung Young Seo
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea
| | - Seong Hun Kim
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea
| | - Sang Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea
| | - Seung Ok Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea
| | - In Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University Hospital-Jeonbuk National University Medical School, 20 Geonjiro, Dukjingu, Jeonju, Jeonbuk, 54907, South Korea.
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Tai CH, Hsu CN, Yang SC, Wu CK, Liang CM, Tai WC, Chuah SK, Lee CH. The impact of aspirin on Klebsiella pneumoniae liver abscess in diabetic patients. Sci Rep 2020; 10:21329. [PMID: 33288865 PMCID: PMC7721809 DOI: 10.1038/s41598-020-78442-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
In this study, we aimed to investigate the impact of aspirin on the risk of pyogenic liver abscess caused by Klebsiella pneumoniae (KP-PLA) and invasive KP-PLA syndrome (IKPS) in diabetic patients. Diabetic patients who were propensity-score matched were retrospectively included from hospital-based database. Kaplan-Meier approach with a log-rank test was used to compare the cumulative incidences of KP-PLA including IKPS between aspirin users and non-users. Totally, 63,500 patients were analyzed after propensity-score matching (1:1). Compared with that of non-users, the incidence of KP-PLA was significantly reduced in aspirin users (0.31% vs. 0.50%, p < 0.01), but not for that of IKPS (0.02% vs. 0.03%, p = 0.29). Patients taking aspirin for ≥ 90 days had a significantly lower risk for KP-PLA (hazard ratio, 0.67; 95%CI, 0.50-0.90). Females, taking clopidogrel or metformin for ≥ 90 days, and taking H2-blockers or proton pump inhibitors (PPIs) for ≥ 5 days were also associated with a lower risk of KP-PLA. However, cholangitis and a glycated hemoglobin ≥ 8.5% were associated with an increased risk of KP-PLA.
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Affiliation(s)
- Chien-Hsiang Tai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. .,College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
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The Surface Protein Fructose-1, 6 Bisphosphate Aldolase of Klebsiella pneumoniae Serotype K1: Role of Interaction with Neutrophils. Pathogens 2020; 9:pathogens9121009. [PMID: 33266305 PMCID: PMC7759916 DOI: 10.3390/pathogens9121009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Hypermucoviscosity phenotypic Klebsiella pneumoniae (HV-Kp) serotype K1 is the predominant pathogen of a pyogenic liver abscess, an emerging infectious disease that often complicates septic metastatic syndrome in diabetic patients with poor sugar control. HV-Kpisolates were more resistant to neutrophil phagocytosis than non-HV-Kpisolates because of different pathogen-associated molecular patterns. The protein expression of HV-Kp after interaction with neutrophils is unclear. We studied KP-M1 (HV phenotype; serotype K1), DT-X (an acapsularmutant strain of KP-M1), and E. coli (ATCC 25922) with the model of Kp-infected neutrophils, using a comparative proteomic approach. One the identified protein, namely fructose-1, 6-bisphosphate aldolase (FBA), was found to be distributed in the KP-M1 after infecting neutrophils. Cell fractionation experiments showed that FBA is localized both to the cytoplasm and the outer membrane. Flow cytometry demonstrated that outer membrane-localized FBA was surface-accessible to FBA-specific antibody. The fba gene expression was enhanced in high glucose concentrations, which leads to increasing bacterial resistance to neutrophils phagocytosis and killing. The KP-M1 after FBA inhibitors and FBA-specific antibody treatment showed a significant reduction in bacterial resistance to neutrophils phagocytosis and killing, respectively, compared to KP-M1 without treatment. FBA is a highly conserved surface-exposed protein that is required for optimal interaction of HV-Kp to neutrophils.
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Hussain I, Ishrat S, Ho DCW, Khan SR, Veeraraghavan MA, Palraj BR, Molton JS, Abid MB. Endogenous endophthalmitis in Klebsiella pneumoniae pyogenic liver abscess: Systematic review and meta-analysis. Int J Infect Dis 2020; 101:259-268. [PMID: 33035676 DOI: 10.1016/j.ijid.2020.09.1485] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Endogenous endophthalmitis (EE) is a devastating complication that develops as a metastatic infection in patients with Klebsiella pneumoniae pyogenic liver abscess (KPPLA). The existing data are heterogeneous and the actual disease burden and risk factors for the development of EE among patients with KPPLA have not been systematically examined. We performed a systematic review and meta-analysis to examine the incidence of EE, temporal trend of EE, and risk factors for EE in patients with KPPLA. METHODOLOGY The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched for articles published from inception to 2020 that evaluated the incidence of EE among patients with KPPLA. By a random-effects method, a pooled estimate of its incidence with 95% confidence intervals was estimated along with examination of its temporal and geographic variations. Pooled odds ratios were calculated for risk factors. RESULTS Fifteen retrospective studies reporting data on 11889 patients with KPPLA met the inclusion criteria and were analyzed. With 217 patients developing EE, the pooled incidence of EE was 4.5% (95% confidence interval 2.4% to 8.2%). The heterogeneity was considerable and significant (Cochran's Q 243.5, p < 0.001, I2 = 94.2%). CONCLUSION This meta-analysis estimates the actual incidence of EE among patients with KPPLA, where EE is reported in about 1 of 22 patients with KPPLA. Infection caused by K1 capsular serotype was an independent risk factor.
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Affiliation(s)
- Ikram Hussain
- Division of Gastroenterology, Department of Medicine, Woodlands Health Campus, Singapore, Singapore.
| | - Saba Ishrat
- Singapore National Eye Centre, Singapore, Singapore
| | - Dawn Ching Wen Ho
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Shahab R Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | | | - Bharath Raj Palraj
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Muhammad Bilal Abid
- Divisions of Infectious Diseases & Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Zhang J, Gao Y, Du Z, Ren Y, Bi J, Wu Z, Lv Y, Wu R. Clinical Features and Prognosis of Gas-Forming and Non-Gas-Forming Pyogenic Liver Abscess: A Comparative Study. Surg Infect (Larchmt) 2020; 22:427-433. [PMID: 32857017 DOI: 10.1089/sur.2020.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Gas-forming pyogenic liver abscess (GFPLA) accounts for up to 30% of all pyogenic liver abscess (PLA) cases. However, little is known of the differences in clinical features and prognosis between GFPLA and non-GFPLA. Aim: This retrospective study compared the clinical features and prognosis of GFPLA and non-GFPLA. Patients and Methods: Data for 392 patients with PLA treated from January 1, 2007 to December 31, 2016 were reviewed. Gas-forming pyogenic liver abscess was defined as gas in the abscess. Liver abscesses were considered non-GFPLA (n = 326) or GFPLA (n = 66). The clinical features and outcomes of patients with GFPLA were compared with that of patients without GFPLA. Results: The groups were similar in gender ratio, age, smoking, drinking, and comorbidities. Klebsiella pneumoniae was the most common pathogenic bacteria, but the negative rate of bacterial culture of the non-GFPLA group was higher than that of the GFPLA. In etiologies, the GFPLA group had more biliary source infection and less cryptogenic infection. In addition, the GFPLA group had a higher rate of previous hepatobiliary surgery, especially biliary enteric anastomosis. Compared with the non-GFPLA group, the percentage of the GFPLA group with antibiotic agents combined with percutaneous drainage was higher, whereas the percentages given antibiotic agents alone and antibiotic agents combined with surgical drainage were lower. Patients with GFPLA had higher rates of sepsis and pleural effusion, and longer hospital stays than did non-GFPLA patients. No patient died during hospitalization. Conclusions: The GFPLA group had more biliary source infection and less cryptogenic infection in etiologies. Gas-forming pyogenic liver abscess is associated with past hepatobiliary surgery, especially biliary enteric anastomosis and has high rates of sepsis and long hospitalization. Thus, the patients with PLA with a history of hepatobiliary surgery should be monitored more closely in the early stage of the PLA. It needs to be recognized as a distinct clinical entity.
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Affiliation(s)
- Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Gao
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Gastrointestinal Surgery Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Zhaoqing Du
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yifan Ren
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jianbin Bi
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Incidence Trends, Comorbidities, and Outcomes of Pyogenic Liver Abscess Among Children: A Nationwide Population-based Analysis. J Pediatr Gastroenterol Nutr 2020; 71:106-111. [PMID: 32142002 DOI: 10.1097/mpg.0000000000002700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Population-based analysis of incidence, comorbid conditions, microbiological characteristics, and outcomes of pyogenic liver abscess (PLA) in children. METHODOLOGY Retrospective analysis of National Inpatient Sample (NIS) and Kids Inpatient database (KID) database from 2003 to 2014 and included patients between 1 and 20 years of age. Using ICD-9 codes, we identified all hospitalizations with PLA and compared them with 1 : 10 age- and gender-matched controls. Amebic liver abscess and Candida infections were excluded. RESULTS Total number of PLA admissions is 4075. The overall incidence of PLA is 13.5 per 100,000 hospitalizations, which increased by 60% between 2003 and 2014. The mean age of patients was 13.03 ± 6.1 years and were predominantly boys-61%. Of the comorbid conditions, hepatobiliary malignancy had the highest odds ratio (OR 71.8) followed by liver transplant (OR 38.4), biliary disease (OR 29.9), inflammatory bowel disease (IBD) (OR 5.35), other GI malignancies (OR 4.74), primary immune deficiency disorder (OR 4.13). Patients with PLA had 12 times increased odds of having associated severe sepsis. Infective endocarditis (IE) (OR 4.5), appendicitis (OR 1.8), and diverticulitis (OR 8.1) were significantly associated with PLA. Almost 39% (1575) of the PLA patients had positive culture, whereas Streptococcus (10.8%) and Staphylococcus spp (9.2%) were the most common pathogens. About 45% of PLA patients underwent percutaneous liver abscess aspiration whereas 4.1% had hepatic resection for PLA. The mortality rate of PLA was 0.8% (n = 32). CONCLUSIONS The incidence of PLA is steadily increasing over the last decade among pediatric population in the United States. Hepatobiliary malignancy and liver transplant are the most common comorbid conditions associated with PLA.
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Liver Abscess due to Streptococcus pneumoniae: A Clinical Rarity. Case Rep Infect Dis 2020; 2020:1572023. [PMID: 32566332 PMCID: PMC7288222 DOI: 10.1155/2020/1572023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
We report a case of pyogenic liver abscess caused by a rare causative agent, Streptococcus pneumoniae. A 45-year-old man with underlying uncontrolled diabetes mellitus who had stopped taking his daily dose of insulin since the last 4 days, presented with pain in the abdominal area of one-day duration. Upon his admission to achieve diabetic control, a routine ultrasound examination of abdomen revealed incidentally, a large abscess in the left lobe of the liver with impending rupture. Culture of the ultrasound-guided liver aspirate pus yielded pure growth of a penicillin-susceptible S. pneumoniae isolate. After 4 weeks of parenteral ceftriaxone therapy along with intensive regimen for diabetic control, the liver abscess became resolved, and the patient improved and was discharged with no residual infection or recurrence at four months and at one-year follow-up. A review of relevant literature related to S. pneumoniae liver abscess revealed a mention of such entity only on 4 previous occasions. The present case highlights an important though rare manifestation of S. pneumoniae infection and emphasizes the need to establish an early diagnosis of S. pneumoniae infection for improved patient survival and favourable outcome.
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Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children. Int J Infect Dis 2020; 98:59-66. [PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children. METHODS We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018. RESULTS Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy. CONCLUSIONS A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.
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Hon JS, Shi ZY, Cheng CY, Li ZY. Applying Data Mining to Investigate Cancer Risk in Patients with Pyogenic Liver Abscess. Healthcare (Basel) 2020; 8:healthcare8020141. [PMID: 32455870 PMCID: PMC7349549 DOI: 10.3390/healthcare8020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022] Open
Abstract
Pyogenic liver abscess is usually a complication of biliary tract disease. Taiwan features among the countries with the highest incidence of colorectal cancer (CRC) and hepatocellular carcinoma (HCC). Few studies have investigated whether patients with pyogenic liver abscess (PLA) have higher incidence rates of CRC and HCC. However, these findings have been inconclusive. The risks of CRC and HCC in patients with PLA and the factors contributing to cancer development were assessed in these patients. The clinical tests significantly associated with cancers in these patients with PLA were determined to assist in the early diagnosis of these cancers. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined using binary logistic regression Cancer classification models were constructed using the decision tree algorithm C5.0 to compare the accuracy among different models with those risk factors of cancers and then determine the optimal model. Thereafter, the rules were summarized using the decisi8on tree model to assist in the diagnosis. The results indicated that CRC and HCC (OR, 3.751; 95% CI, 1.149–12.253) and CRC (OR, 6.838; 95% CI, 2.679–17.455) risks were higher in patients with PLA than those without PLA. The decision tree analysis demonstrated that the model with the PLA variable had the highest accuracy, and that classification could be conducted using fewer factors, indicating that PLA is critical in HCC and CRC. Two rules were determined for assisting in the diagnosis of CRC and HCC using the decision tree model.
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Affiliation(s)
- Jau-Shin Hon
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407, Taiwan; (J.-S.H.); (Z.-Y.S.); (Z.-Y.L.)
| | - Zhi-Yuan Shi
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407, Taiwan; (J.-S.H.); (Z.-Y.S.); (Z.-Y.L.)
- Infectious Control Center, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 106, Taiwan
| | - Chen-Yang Cheng
- Department of Industrial Engineering & Management, National Taipei University of Technology, Taipei 106, Taiwan
- Correspondence:
| | - Zong-You Li
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407, Taiwan; (J.-S.H.); (Z.-Y.S.); (Z.-Y.L.)
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Mukthinuthalapati VVPK, Attar BM, Parra-Rodriguez L, Cabrera NL, Araujo T, Gandhi S. Risk Factors, Management, and Outcomes of Pyogenic Liver Abscess in a US Safety Net Hospital. Dig Dis Sci 2020; 65:1529-1538. [PMID: 31559551 DOI: 10.1007/s10620-019-05851-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The causes and management of pyogenic liver abscess (PLA) have undergone multiple changes over the past decades. It is a relatively rare disease in the USA, and its incidence rate in the USA is increasing. The last US community hospital experience of PLA was published in 2005. We performed a retrospective study of patients admitted with PLA to an urban safety net hospital. AIMS To ascertain risk factors, management approaches, and outcomes of PLA. METHODS Electronic medical record was queried for diagnosis codes related to PLA during the years 2009-2018. Clinical information was compiled in an electronic database which was later analyzed. Main study outcomes were in-hospital mortality, 30-day readmission rate, and intensive care utilization rate. RESULTS A total of 77 patients with PLA were admitted in the study period. Most common risk factors were diabetes mellitus (23.4%), previous liver surgery (20.7%), and hepatic malignancy (16.9%). 89% of patients were treated with percutaneous drainage or aspiration, and surgical drainage was reserved for other with other indications for laparotomy. In-hospital mortality, 30-day readmission, and intensive care utilization rates were 2.6%, 7% and 22%, respectively. Median length of stay was 11 days (inter-quartile range 7). Rate of antimicrobial resistance in abscess fluid cultures was 40%; 13 cases of Klebsiella pneumoniae liver abscess were noted in our cohort, most of whom were Hispanic or Asian. CONCLUSIONS PLA was principally managed by percutaneous drainage or aspiration with good outcomes. Further studies investigating the racial predilection of K. pneumoniae liver abscesses could reveal clues to its pathogenesis.
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Affiliation(s)
| | - Bashar M Attar
- Division of Gastroenterology, Cook County Health, 1950 W Polk St, 6th Floor, Chicago, IL, 60612, USA
| | - L Parra-Rodriguez
- Department of Medicine, Cook County Health, 1950 W Polk St, 6th Floor, Chicago, IL, 60612, USA
| | - Nicolo L Cabrera
- Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science, 6431 Fannin St, MSB 2.112, Houston, TX, 77030, USA
| | - Tiago Araujo
- Department of Medicine, Cook County Health, 1950 W Polk St, 6th Floor, Chicago, IL, 60612, USA
| | - Seema Gandhi
- Division of Gastroenterology, Cook County Health, 1950 W Polk St, 6th Floor, Chicago, IL, 60612, USA
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Long-term Outcome of Neurological Complications after Infective Endocarditis. Sci Rep 2020; 10:3994. [PMID: 32132599 PMCID: PMC7055329 DOI: 10.1038/s41598-020-60995-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
Severe neurological complications following infective endocarditis remain a major problem with high mortality rate. The long-term neurological consequences following infective endocarditis remain uncertain. Otherwise, neurosurgeries could be performed after these complications; however, few clinical series have reported the results. Therefore, we utilized a large, nationwide database to unveil the long-term mortality and neurosurgical outcome following infective endocarditis. We included patients with a first-time discharge diagnosis of infective endocarditis between January 2001 and December 2013 during hospitalization. Patients were further divided into subgroups consisting of neurological complications under neurosurgical treatment and complications under non-neurosurgical treatment. Long-term result of symptomatic neurological complications after infective endocarditis and all-cause mortality after different kinds of neurosurgeries were analyzed. There were 16,495 patients with infective endocarditis included in this study. Symptomatic neurological complications occurred in 1,035 (6.27%) patients, of which 279 (26.96%) accepted neurosurgical procedures. Annual incidence of neurological complications gradually increased from 3.6% to 7.4% (P < 0.001). The mortality rate among these patients was higher than that among patients without complications (48.5% vs. 46.1%, P = 0.012, increased from 20% initially to nearly 50% over the 5-year follow-up). However, neurosurgery had no effect on the long-term mortality rate (50.9% vs. 47.6%, P = 0.451). Incidence of neurological complications post-infective endocarditis is increasing, and patients with these complications have higher mortality rates than patients without. Neurosurgery in these populations was not associated with higher long-term mortality. Therefore, it should not be ruled out as an option for those with neurological complications.
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Du Z, Zhou X, Zhao J, Bi J, Ren Y, Zhang J, Lin Y, Wu Z, Lv Y, Zhang X, Wu R. Effect of diabetes mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization. BMC Infect Dis 2020; 20:145. [PMID: 32066406 PMCID: PMC7027105 DOI: 10.1186/s12879-020-4855-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is an inflammatory disease with increasing incidence. When it occurs with diabetes mellitus (DM), the risk of recurrence and mortality may increase. However, the effect of DM on the short-term prognosis of PLA patients after hospitalization remained unknown. METHODS Two hundred twenty-seven PLA patients who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to January 2018 were retrospectively enrolled. They were divided into two groups as the DM group (n = 61) and the Non-DM group (n = 166). In the DM group, HbA1C level < 7% was considered to be good-control of glycaemia (n = 23). The clinical characteristics and overall short-term survival were analyzed. RESULTS The proportion of PLA patients with DM was 26.87%. In the DM group, there was a higher incidence of hypertension and Candida spp. infection. Conservative administration and percutaneous drainage were mainly used in patients with good- (60.87%) and poor-control (60.53%) of glycaemia, respectively. During follow-up, 24 (10.57%) died due to uncontrolled systemic infections and other serious complications. Compared with PLA patients without DM, patients in the DM group had significantly increased 6-month mortality rate after discharge (Log-Rank test, P = 0.021). Poor-control of glycaemia did not reduce the six-month survival, while the recurrence rate of PLA within 3 months showed an almost 3-fold increase (13.16% vs. 4.35%). Further multivariate analyses found that DM was the only independent risk factor for the PLA six-month survival (odds ratio [OR]: 3.019, 95% confidence interval [CI]: 1.138-8.010, P = 0.026). However, the blood glucose level had no significant effect on the short-term survival of PLA patients with DM (Log-Rank test, P = 0.218). CONCLUSIONS In PLA patients, DM aggravated short-term mortality and blood glucose levels should be well controlled.
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Affiliation(s)
- Zhaoqing Du
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Xingchen Zhou
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Junzhou Zhao
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jianbin Bi
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yifan Ren
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jia Zhang
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yuxin Lin
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yi Lv
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Xufeng Zhang
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China. .,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
| | - Rongqian Wu
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
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Zhang S, Zhang X, Wu Q, Zheng X, Dong G, Fang R, Zhang Y, Cao J, Zhou T. Clinical, microbiological, and molecular epidemiological characteristics of Klebsiella pneumoniae-induced pyogenic liver abscess in southeastern China. Antimicrob Resist Infect Control 2019; 8:166. [PMID: 31673355 PMCID: PMC6819602 DOI: 10.1186/s13756-019-0615-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) has emerged as a life-threatening disease worldwide. However, to date, a limited number of scholars have attempted to systematically elucidate the characteristics of KP-PLA. The aim of the present study was to analyze clinical, microbiological, and molecular epidemiological characteristics of KP-PLA patients in Southeastern China. Methods The KP-PLA cases from a tertiary teaching hospital in China from January 2016 to December 2017 were systemically studied and elucidated comprehensively. The virulence factors, resistant spectrum, and clones of K. pneumoniae isolates were identified with string test, polymerase chain reaction (PCR), antimicrobial susceptibility test, and multilocus sequence typing. Moreover, the characteristics in KP-PLA patients with and without other hepatobiliary diseases (OHD) were also been compared. Results A total of 163 KP-PLA cases were enrolled, in which the majority of those cases were senior males, and often associated with multiple underlying diseases, including diabetes (49.7%). The remaining cases belonged to healthy individuals (50.3%). The clinical symptoms were common but nonspecific, characterized by increased inflammatory parameters and abnormal liver function parameters. The abscess was often right-sided solitary presentation (58.3%). Cephalosporin or carbapenem plus metronidazole combined with percutaneous puncture or catheter drainage were favorable therapeutics. Although low resistance rates of commonly used antimicrobial drugs (< 10%) were observed, twelve strains were identified as multidrug resistant (MDR) strains, and were mainly isolated from the OHD patients. The hypermucoviscosity, as well as K1 and K2 serotypes accounted for 30.7, 40.5, and 19.0%, respectively. Except for iroN (24.5%) and magA (45.4%), the high prevalence of virulence genes (e.g. aerobactin, rmpA, mrkD, fimH, uge, ureA, entB, ybtA, kfuBC, and wcaG) was identified (68.7–100.0%). Additionally, ST23 was found as a predominant sequence type (ST; 38.7%), and three novel STs (ST3507, ST3508 and ST3509) were noted as well. Conclusions The present study reported the abundant hvKp strains in KP-PLA, as well as convergence of hypervirulent and MDR K. pneumoniae isolates from the KP-PLA patients, particularly those cases with OHD. Given the various clinical manifestations and destructive pathogenicity, determination of the comprehensive characteristics of such isolates is highly essential to effectively carry out for optimal management and treatment of KP-PLA.
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Affiliation(s)
- Siqin Zhang
- 1Department of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Xiucai Zhang
- 1Department of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Qing Wu
- 1Department of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Xiangkuo Zheng
- 2School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, 325000 China
| | - Guofeng Dong
- 2School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, 325000 China
| | - Renchi Fang
- 1Department of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Yizhi Zhang
- 1Department of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
| | - Jianming Cao
- 2School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, 325000 China
| | - Tieli Zhou
- 1Department of Clinical Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 China
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