Enterococcal pyogenic liver abscesses: high risk of treatment failure and mortality

Oliosi, Emma; Rossi, G.; Nguyen, Yann; Honsel, Vasco; Bert, Frédéric; Roux, Olivier; Fantin, Bruno; Lefort, A.

doi:10.1007/s10096-022-04543-z

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Compared to other pathogens, enterococcal etiology could indicate an unfavorable outcome in our study, with a high rate of Enterococcus spp in patients who died within 90 days and who experienced a relapse. This is in accordance with a study from France, where enterococcal etiology was associated with death but not recurrence [ 32 ]. We were not able to establish the number of patients who received appropriate empiric therapy for their PLA.…”

Section: Discussionsupporting

confidence: 93%

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Bläckberg

Jönsson

Svensson

et al. 2023

Open Forum Infectious Diseases

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Aim Pyogenic liver abscess (PLA) is a rare entity but, is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in Southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern part of Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (OR 2.0, 95% CI 1.1-3.9), malignancy (OR 3.7, 95% CI 1.9-7.1), liver failure (OR 6.3, 95% CI 2.7-14.5) and polymicrobial findings (OR 3.8, 95% CI 2.2-6.9) were associated with death within 90 days, p < 0.05. Male sex (OR 2.1, 95% CI 1.2-3.6), malignancy (OR 2.2, 95% CI 1.3-3.6), age (65-74 years) (OR, 2.2, 95% CI 1.2-4.1) and chronic liver disease (OR 3.0, 95% CI 1.4-6.4) were associated with the risk of subsequent PLA, p ≤ 0.01. Conclusions Identifying different clinical variables associated with an unfavourable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.

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Section: Discussionsupporting

confidence: 93%

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Bläckberg

Jönsson

Svensson

et al. 2023

Open Forum Infectious Diseases

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“…This is consistent with data from other studies in which positive blood cultures in PLA patients were also associated with increased mortality 16 , 37 . In contrast to our results, other studies indicated an increased mortality when enterococci were detected 40 , 42 , 44 . It should be discussed whether empirical therapy should be extended to cover enterococci in selected patients with severe diseases, risk factors for enterococcal infections such as immunosuppression or previous long-term treatment with cephalosporins.…”

Section: Discussioncontrasting

confidence: 99%

“…A possible explanation for this observation is the interdisciplinary liver center at our hospital with a large liver transplant program; a center effect is therefore likely. On the other hand, there are indications of a general shift in etiology: whereas decades ago appendicitis, trauma, post-surgical complications or hematogenous spread were common causes, in recent years diseases of the hepatic-pancreatic-biliary system have increasingly become the cause of PLA 14 , 17 , 34 – 36 , 38 , 41 , 42 , 44 . This is certainly due to a changed patient clientele with older and more multi-morbid patients with underlying malignant diseases or immunosuppression, paired with an increasing willingness for medical intervention.…”

Section: Discussionmentioning

confidence: 99%

Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital

Wendt,

Bačák,

Petroff

et al. 2024

Sci Rep

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Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.

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“…This may be because poor control of glucose levels leads to impaired neutrophil activity and phagocytosis, thereby reducing bacterial clearance and the efficient control of infections [ 5 , 22 ]. Biliary tract infection is one of main pathogenic mechanisms responsible for PLA, and is more common in non-KP infections, such as those from Enterococcus [ 23 ]. Cholelithiasis and neoplastic obstruction are common causes of biliary tract disease, and we found significantly higher proportions of patients with these two conditions in our non-KPPLA group.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the non-KPPLA group had two AIDS patients, each with a Charlson comorbidity index of 6, and this also contributed to the poorer prognosis of this group. Patients in the non-KPPLA group were infected with a variety of bacterial species, some of which are associated with poor prognosis [ 23 , 32 ]. For example, Escherichia coli is believed to be closely related to biliary tract involvement, and these patients can have complex underlying diseases and low immunity due to cancer and malnutrition, which may contribute to their poor prognoses [ 6 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

Xu,

Liu,

et al. 2024

Heliyon

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Enterococcal pyogenic liver abscesses: high risk of treatment failure and mortality

Cited by 5 publications

References 24 publications

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

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