Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

Abstract

Background Klebsiella pneumoniae is a primary pathogen of pyogenic liver abscess (PLA). However, little data are available on combination with sepsis. In this study, we aimed to evaluate the clinical characteristics and prognostic differences of PLA patients with sepsis. Methods This retrospective cohort study was conducted to investigate 135 patients with confirmed Klebsiella pneumoniae-caused liver abscesses (KPLA) from a tertiary teaching hospital, from 2013 to 2019. The patients were divided into two groups, KPLA with sepsis and KPLA without sepsis. The demographic characteristics, clinical features as well as laboratory and microbiologic findings were analyzed. Results A total of 135 patients with KPLA were analyzed. The mean age of patients was 60.9 ± 12.7 years, and the percentage of men was 59.3%. Among them, 37/135 (27.4%) of patients had sepsis and the mortality rate was 1.5%. The most common symptom was fever (91.1%). KPLA patients with sepsis had a significantly higher proportion of frailty, diarrhea, fatty liver, chronic renal insufficiency, and hepatic dysfunction compared to KPLA patients without sepsis (p < 0.05). Antibiotic therapy and percutaneous drainage were most frequently therapeutic strategy. Furthermore, the incidences of sepsis shock and acute respiratory distress syndrome were higher in the sepsis group compared to the non-sepsis group. As for metastatic infections, the lung was the most common site. In addition, KPLA patients with sepsis showed respiratory symptoms in 11 patients, endophthalmitis in 4 patients, and meningitis in 1 patient. Conclusion Our findings emphasize that KPLA patients combined with or without sepsis have different clinical features, but KPLA patients with sepsis have higher rates of complications and metastatic infections. Taken together, further surveillance and control of septic spread is essential for KPLA patients.

Epidemiological Features and Impact of High Glucose Level on Virulence Gene Expression and Serum Resistance of Klebsiella pneumoniae Causing Liver Abscess in Diabetic Patients

“…The major abnormalities of KLA in the laboratory were increased CRP and liver dysfunction. 32,33 It was also demonstrated in this investigation that the levels of CRP in diabetic-KLA patients were higher, which suggested a more severe infection. Sepsis is a lethal organ dysfunction caused by a dysregulated host response to an infection.…”

“…Septic-KLA patients had an increased risk of chronic metastatic complications and prolonged hospital stays. 33 The results from this research indicated that the incidence of sepsis was higher and the hospital stays were longer in KLA with diabetes. In this study, the virulence genes and capsular serotypes were detected by PCR.…”

Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses

“…All authors report Klebsiella pneumoniae and E. coli as the most common bacteria cultured in pus from PLA [ 1 , 24 , 27 , 28 , 31 , 34 ], with E. coli being more frequently associated with biliary diseases [ 1 , 23 , 31 ] and diabetes mellitus [ 35 , 36 ].…”

Epidemiological Features of Klebsiella pneumoniae Infection in the Hepatobiliary System of Patients in Yantai, China, Based on Clinical and Genetic Analyses

“…Our results indicated that men are more likely to develop hvKP infection than women (72% vs 28%), and the average age of patients was 61 years, which is consistent with previous studies. 11 Diabetes is generally considered to be a significant risk factor for acquiring a hvKP infection, but not cKP infection. 12 , 13 The reason for this may be that increased serum glucose levels can increase capsule production.…”