Protocol-based management of 154 cases of pediatric liver abscess

Choudhury, Subhasis Roy; Khan, Niyaz Ahmed; Saxena, Rahul; Yadav, Partap Singh; Patel, Jigar N; Chadha, Rajiv

doi:10.1007/s00383-016-4009-8

Cited by 17 publications

(42 citation statements)

References 24 publications

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“…However, a pediatric study in Taiwan and several adult studies have found that the spectrum of pathogenic bacteria has changed, and Klebsiella pneumoniae and Escherichia coli have gradually become the main pathogens. 2,5,6 The results of this study are similar to those in Taiwan. The possible reasons for this situation are that the incidence of Staphylococcus aureus is low in the author's area due to relatively good economic, medical and health conditions.…”

Section: Discussionsupporting

confidence: 84%

“…In this study, cryptogenic liver abscesses accounted for 52.6%, while a study of children in Taiwan showed that cryptogenic liver abscesses accounted for 70-80%. 5,6 Fever and abdominal pain are the most common symptoms. This study suggests that the right lobe of the liver is the most common site of bacterial liver abscesses, so right upper abdominal pain is more common, and some children have symptoms such as cough, shortness of breath and chest pain caused by the liver abscess stimulating the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of the Clinical Characteristics of 19 Cases of Bacterial Liver Abscesses in Children and A Review of the Literature

Yuanxi

Jiang

Qihua

2021

Preprint

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Background To analyze the clinical characteristics of 19 children with bacterial liver abscesses and to explore the diagnosis, treatment and prognosis of children with bacterial liver abscesses. Methods Children with bacterial liver abscesses were selected from July 01, 2011, to July 31, 2020, at the Affiliated Children's Hospital of Suzhou University. The onset age, sex, clinical manifestations, imaging and laboratory examination data, treatment and outcomes were analyzed and summarized, and a literature review was performed. Results The average diagnostic age of 19 cases of bacterial liver abscesses was 5 ± 6.7 years old, and the ratio of males to females was 1.7. Ten cases had underlying diseases, including 8 cases of hematological diseases (including leukemia and aplastic anemia) (42.1%), 1 case of a choledochal cyst (5.3%) and 1 case of abdominal trauma (5.3%). The most common clinical manifestations were fever (16 cases, 84.2%), followed by right upper abdominal pain (9 cases, 44.4%) and cough and pleural effusion (6 cases, 31.6% each). Among the laboratory indexes, increases in serum C-reactive protein and leukocytosis were the most common, with 19 cases (100%) and 9 cases (44.4%), respectively. The proportion of patients with abnormal liver function was not high, and there were no cases of elevated bilirubin. The most common pathogens in pus and blood cultures were Klebsiella pneumoniae and Escherichia coli. Nineteen children with bacterial liver abscesses were treated with intravenous antibiotics, and the average duration of intravenous antibiotic use was 28.4 ± 14.7 days. Among the cases, 13 cases (68.4%) were treated with antibiotics alone, and 5 cases (26.3%) and 1 case (5.3%) were treated with percutaneous needle aspiration and surgical drainage, respectively. All 19 children with bacterial liver abscesses improved, and there were no complications or deaths. Conclusion The most common underlying disease was a hematological malignant tumor. Klebsiella pneumoniae and Escherichia coli were the most common pathogens in blood and abscess cultures. Through appropriate antibacterial treatment and timely drainage, the prognosis is usually good.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Analysis of the Clinical Characteristics of 19 Cases of Bacterial Liver Abscesses in Children and A Review of the Literature

Yuanxi

Jiang

Qihua

2021

Preprint

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“…Liver abscess is an important yet relatively uncommon disease in children, with varied incidence and prevalence worldwide (1). Liver abscess is uncommon in developed countries but remains a significant infectious issue for children residing in developing countries (2)(3)(4). The incidence rates reported in previous studies ranged from 25 per 100,000 pediatric admissions in the USA, 79 per 100,000 pediatric admissions in India, and up to 400 per 100,000 pediatric admissions in Cote d'Ivoire (3,5,6).…”

Section: Introductionmentioning

confidence: 99%

“…Overall, the treatment outcome has been improving gradually with higher clinical suspicion and rigorous treatment, although we still possess no consensual algorithm. The mortality rate due to liver abscess has dropped from 40% in the 1980s to below 15% (2,4,11).…”

Section: Introductionmentioning

confidence: 99%

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

et al. 2020

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Background: Liver abscess is an important but relatively rare disease in children. This study investigated the clinical characteristics of eligible patients at a referral tertiary center over the past two decades. Method: A 20-year retrospective study (January 2000-December 2019) enrolled 38 children diagnosed with liver abscess. Demographic data; clinical features; laboratory, imaging, and microbiological findings; management strategy; and outcomes were reviewed from the patients' medical records. Results: Thirty-eight cases of pyogenic liver abscess were identified without a culture-proven amebic or fungal abscess. The mean age of diagnosis was 9.6 ± 6.2 years, and the male-to-female ratio was 1.92: 1. Hemato-oncological (28.9%) and predisposing hepatobiliary diseases (23.7%) were the two most common predisposing factors. Fever (94.7%) was the most common presentation followed by right upper quadrant abdominal pain (42.1%) and pleural effusion (34.2%). Among the laboratory parameters, leukocytosis was common (70.3%), and all patients had elevated serum C-reactive protein levels. Increased serum levels of alanine aminotransferase, aspartate aminotransferase, direct bilirubin, and total bilirubin were found in 40.5, 48.6, 23.1, and 42.9% of the cases, respectively. The most common pathogen in blood and pus cultures was Klebsiella pneumoniae. The mean durations of intravenous antibiotic and total antibiotic use were 29.0 ± 15.7 and 45.1 ± 22.1 days, respectively. Twelve patients (31.6%) were treated with antibiotics alone, while percutaneous needle aspiration, percutaneous pigtail drainage, and surgical intervention were performed in 12 (31.6%), 10 (26.3%), and 5 (13.2%) patients, respectively. No mortality was documented in this series. Conclusion: The present study reflects a relatively declining incidence of liver abscess compared with prior studies in Taiwan. K. pneumoniae remains the most prevalent pathogen in both blood and abscess cultures in Taiwan. Proper antimicrobial therapy with timely drainage generally yielded an adequate treatment response without any mortality.

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“…However, the standard therapeutic management according to abscess size in PLA patients remains unclear [6,8,[14][15][16][17][18][19][20][21][22]. Kulhari and Mandia [19] suggested that percutaneous catheter drainage (PCD) is a better choice as compared to PNA especially in large abscesses that are partially liquefied.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous fine-needle aspiration for pyogenic liver abscess (3-6 cm): a two-center retrospective study

Wang

et al. 2020

BMC Infect Dis

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Background: The role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter. The objective of this study was to evaluate the comparative effectiveness and safety of PNA combined with antibiotics. Methods: This was a retrospective study of patients with PLA that were from 3 to 6 cm in diameter who treated at two medical centers in Shanghai, China, from January 2014 to March 2019. Patients were divided into groups treated by PNA plus antibiotics or antibiotics alone. Patients demographics and clinical data related diagnosis, antibiotic treatment, and patient outcomes were analyzed. Results: Out of a total of 94 PLA patients, 42 (44.7%) patients received PNA combined with antibiotics, and 52 (55.3%) received antibiotics alone. There were no complications related to PNA. In the PNA group, 13 (31.7%) patients with negative blood culture and 8 (19.5%) patients without blood culture were microbiologically confirmed via aspiration. The time for temperature normalization (P < 0.001) and the reduction rate of C-reactive protein within the first week (P = 0.031) were significantly lower in the PNA group. In the multivariate analysis, treatment with PNA was more likely to result in clinical improvement of PLA (odds ratio = 0.33, 95% confidence intervals (CI): 0.11-0.96, P = 0.043). Conclusions: PNA combined with antibiotics appears to be a safe, effective, and promising treatment for PLA of 3-6 cm in size. Furthermore, the technique allows for direct microbial sample, which can improve the selection of antibiotics.

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Protocol-based management of 154 cases of pediatric liver abscess

Abstract: Ultra-sonography was useful for the initial diagnosis, monitoring the progress and management of LA in children. The outcome of a protocol-based management of LA in children was favorable.

Cited by 17 publications

References 24 publications

Analysis of the Clinical Characteristics of 19 Cases of Bacterial Liver Abscesses in Children and A Review of the Literature

Analysis of the Clinical Characteristics of 19 Cases of Bacterial Liver Abscesses in Children and A Review of the Literature

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center

Percutaneous fine-needle aspiration for pyogenic liver abscess (3-6 cm): a two-center retrospective study

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