Characteristics and management of pyogenic liver abscess

Abstract

Pyogenic liver abscess (PLA) are space-occupying lesions in the liver associated with high morbidity and mortality. The aim of this study is to review an Italian hospital experience in epidemiological, clinical patterns, and management of PLA.We performed a retrospective, descriptive case series at a single center assessing demographic characteristics, presentation patterns, etiological factors, microbiological etiology, and management for patients treated for PLA between 2000 and 2016.Around 109 patients were identified. The majority of patients presented with fever (73%); right upper abdominal pain in 63.3%, vomiting and nausea in 28.4%. The most common laboratory abnormality among included items was increased C-reactive protein and fibrinogen blood levels, respectively, in 98% and 93.9% of cases. Abdominal ultrasound was the diagnostic investigation in 42.4% of cases; CT scan and MR imaging were performed in 51.1% and 3.3% of cases respectively. We observed blood or pus culture study in 99 cases of which only 53.5% came with positive microbial reports. The most common organism identified was Escherichia coli (26.5%), followed by Streptococcus spp (13.2%). Early antibiotic treatment started on all patients and 66.7% of cases required different approaches, Ultrasound or CT-guided needle aspiration of PLA was performed in 13 patients (11%) and percutaneous abscess drainage was performed on 72 patients (67%).PLA is a diagnostically challenging problem due to nonspecific presenting characteristics. The microbiological yield identified was a typical European spectrum with a preponderance of Escherichia coli infections. Once recognized, percutaneous drainage and antibiotic treatment are the mainstay of management for PLA.

Liver abscess: demographic, clinical, biochemical, imaging and microbial spectrum

“…In this study mean leukocyte count was 15.790±7.173 in pyogenic abscess in contrast to amoebic liver abscess 9.184±2.372 with a significant p value of <0.0001. This finding of higher leukocyte count in pyogenic liver abscess was in agreement to study conducted by Serraino C et al 23 When pus was obtained and cultured from the abscess or blood cultures from patients with pyogenic liver abscesses revealed Klebsiella pneumoniae was the dominant organism found in 28(51.85%) subjects followed by polymicrobial in 13(24.07.0%), Escherichia coli in 07(12.96%) and cryptogenic (no growth) in 06(11.11%). K. pneumoniae being a commonest culprit was also supported by different studies carried out in Asian countries like Taiwan, China, Korea, Singapore and Pakistan.…”

Effect of diabetes mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization

“…DM can also cause systemic metabolic disorders and impaired immunity, which weakens the ability of the liver to clear bacteria, making the bacteria easy to colonize and multiply to form abscesses [11]. Studies have confirmed that although the incidence of DM in PLA patients is [7,[12][13][14]. Even in PLA patients caused by Klebsiella pneumonia, the incidence of DM is higher as 49.7%.…”

“…Unexpectedly, leukocytes count showed a higher abnormal at admission in the Non-DM group, which might be related to the heavier inflammatory status in this group. Bacterial culture revealed that Klebsiella pneumonia and Escherichia coli were still the two most common infectious pathogens, whether or not combined with DM [6,12,19]. Interestingly, pus culture results illustrated 2 cases of Candida spp.…”

Comparative evaluation of interventional radiology modalities in treatment of liver abscess

“…The finding of better results with PCD has also been noted by others. 1,15 There are certain advantages with PCD. These include single time skin puncture, placement of a catheter for further lavage of abscess cavity, monitoring of the cavity content etc.…”