Biliary diseases as main causes of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae

Abstract

Background & Aims Little is known about aetiology and morbidity and clinical characteristics of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Methods An analysis between pyogenic liver abscess patients caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates and those caused by non‐extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae was performed. Results Among 817 pyogenic liver abscess patients, there were 176 patients (21.5%) with pyogenic liver abscess of biliary origin, and 67 pyogenic liver abscess patients (8.2%) caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates (mainly Escherichia coli and Klebsiella pneumoniae). Of 176 pyogenic liver abscess patients related to biliary disorders, there were 48 pyogenic liver abscess patients (27.3%) caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Within 67 pyogenic liver abscess patients caused by Enterobacteriaceae expressing extended‐spectrum beta‐lactamases, the occurrences of 48 pyogenic liver abscess patients (71.6%) were associated with biliary disorders. When compared with pyogenic liver abscess patients caused by non‐extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae, there were significantly greater incidences of polymicrobial infections, bacteremia, pulmonary infection, recurrence and death in pyogenic liver abscess patients caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Carbapenems remain mainstay drugs against extended‐spectrum beta‐lactamase‐producing E. coli and K. pneumoniae. Independent risk factors for occurrence of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae were biliary disorders including extra‐ and intrahepatic cholangiolithiasis and an abnormal bilioenteric communication between bile and gut, a treatment history of malignancy such as operation and chemotherapy, pulmonary infection, and diabetes mellitus. Conclusions Pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates mainly occurs in patients with biliary disorders or with a treatment history of malignancy. The mainstay of treatment remains carbapenems in combination with adequate aspiration or drainage.

Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies

“…4,7,34 PLA of biliary origin is defined as PLA related to biliary tract diseases such as acute cholecystitis or acute cholangitis caused by any form of biliary pathologies such as IBDS and extrahepatic bile duct stone (EBDS), abnormal communications between bile duct and gut including papillotomy, biliary stents, and bilioenteric anastomosis, and biliary duct abnormality such as congenital choledochal cyst and intrahepatic biliary stricture, bile duct stricture, and biliary complications related to HAT after OLT. 4,5,[28][29][30] HAT in OLT recipients can cause biliary ischemia, pyogenic cholangitis, and bile duct stenosis and necrosis. 29,30…”

“…4,22 The occurrences of PLA caused by extendedspectrum β-lactamase (ESBL)-producing Enterobacteriaceae isolates are significantly associated with biliary disorders including extra-and intrahepatic cholangiolithiasis, and abnormal bilioenteric communications between bile and gut such as bilioenteric anastomosis and biliary stent. 5 In a healthy person, the biliary tree is normally sterile due to prevention of intestinal bacteria entering into bile duct by Oddi's sphincter; but biliary pathology is often associated with secondary biliary bacterial colonization. [35][36][37] Hepaticojejunostomy, as a part of hepatobiliary surgery with the resection or bypass of Oddi's sphincter, is generally con-sidered to have excellent results; nevertheless, 6 to 15% of patients with hepaticojejunostomy develop cholangitis.…”

“…4,31 There is likely to be antecedent attacks of acute cholangitis associated with biliary tract diseases or their treatment history, of which those related diseases include IBDS and EBDS, hepatopancreatobiliary benign disorders or malignancies treated by one part of operations with a papillotomy, extraction of biliary stones, endoscopic nose-biliary drainage, biliary stent, bilioenteric anastomosis, or the presence of biliary strictures or HAT after OLT. 4,5,20,[28][29][30] Patients with PLA of biliary origin at admission tend to be more frail and underweight (lower body mass index). 4,31 Pneumobilia, leukocytosis, hypoalbuminemia, hyperbilirubinemia, and reversed albumin-globulin ratio are more often encountered in patients with PLA of biliary origin.…”

“…foremost presumed etiology of PLA worldwide, 4,5,32 our aim is systematically reviewing on clinical manifestations, pathogens, treatment, recurrence, and death in patients with PLA of biliary origin. Of note, we review the existing problems such as difficulties in infectious control and diagnosis of concomitant cholangiocarcinoma, and treatment in patients with PLA related to IBDS.…”

A unique case of metastatic spinal epidural abscess associated with liver abscess following ascending cholangitis and Escherichia coli bacteremia

“…The annual incidence is 2.3 cases per 100,000 people according to a retrospective study conducted in the UK [6]. A particularly high rate of pyogenic liver abscesses (PLA) was reported in Southeast Asia [7]. PLA is a life-threatening infection with a mortality rate that may reach 12% [6].…”