Pneumonia is an independent risk factor for pyogenic liver abscess: A population-based, nested, case-control study

Abstract

BackgroundBacteremic pneumonia is considered a potential cause of distal organ abscess formation. Therefore, we hypothesize that pneumonia is a risk factor for pyogenic liver abscess (PLA).The aim of this study is to explore the association between pneumonia and PLA.Methodology/Principal findingsA nationwide, population-based, nested, case–control study was conducted using data from the Taiwan National Health Insurance Research Database. In total, 494 patients with PLA and 1,976 propensity score matched controls were enrolled. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) in patients with exposure to pneumonia before PLA. After matched and adjusted for confounding factors including age, sex, urbanization, income, chronic liver disease, alcohol-related disease, biliary stone, chronic kidney disease, diabetes mellitus, chronic liver disease, and cancer, hospitalization for pneumonia remained an independent risk factor for PLA with an aORs of 2.104 [95% confidence interval (CI) = 1.309–3.379, p = 0.0021]. Moreover, the aORs were significantly higher among patients hospitalized for pneumonia within 30 days (aORs = 10.73, 95% CI = 3.381–34.054), 30–90 days (aORs = 4.698, 95% CI = 1.541–14.327) and 90–180 (aORs = 4.000, 95% CI = 1.158–13.817) days before PLA diagnosis.ConclusionPneumonia is an independent risk factor for subsequent PLA. Moreover, hospitalization for pneumonia within 180 days before PLA diagnosis was associated with an increased risk of PLA.

Analysis of the clinical characteristics of 202 patients with liver abscess associated with diabetes mellitus and biliary tract disease

“…Diabetes mellitus, biliary disease, pneumonia, proton pump inhibitors, alcoholism, and malignant tumors are the risk factors for PLA. 4 , 8 – 10 The common pathogenic bacteria of PLA dynamically change, 11 and Klebsiella has gradually become the main pathogen of bacterial liver abscess in Asia. Although Enterobacteriaceae producing superspectrum β-lactamases (ESBLs) have been reported to cause liver abscesses, they are still rare.…”