Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors

Abstract

Background: pyogenic liver abscess (PLA) is a potentially life-threatening disease in middle-to-old aged persons. Objective: to compare the differences in clinical features and outcomes between older and younger PLA patients, and to identify predictors of outcomes in older patients. Design: retrospective chart review of all PLA patients between July 1999 and June 2007. Setting: a 1,600-bed primary and tertiary care centre. Subjects: in total, 339 patients were enrolled and included 118 ≥65 years of age (the elderly group) and 221 patients <65 years of age (the non-elderly group). Methods: clinical features, laboratory, imaging and microbiologic findings, treatment and outcomes for each of the included patients were collected. The predictor of outcome was determined using logistic regression and purposeful selection of covariates. Results: the elderly group had a higher APACHE II score on admission, a biliary abnormality, a malignancy, a pleural effusion, polymicrobial, anaerobic or multi-drug-resistant isolates, inappropriate initial antibiotics, a longer hospitalisation and a longer parenteral antibiotic treatment period than the non-elderly group, whereas the non-elderly group was more likely to be alcoholic men with cryptogenic origin of abscess and Klebsiella pneumoniae infection. There was no difference in case fatality between the elderly (13.6%) and non-elderly (8.6%) groups despite the elderly group having a poorer host status on admission. In multivariate analysis, age (P = 0.028) and APACHE II score at admission ≥15 (P = 0.001) were risk factors, but K. pneumoniae infection (P = 0.012) was a protective factor for fatality in older PLA patients. Conclusions: these data suggest that older PLA patients wound have a fair outcome compared to younger patients, but require longer hospitalisations.

Penetration of moxifloxacin into liver tissue

“…Whilst decades ago pyogenic liver abscesses were mostly seen as a complication of acute abdominal infections such as acute appendicitis, today the mean age of patients has increased and bacterial liver infections are found to be associated with malignant diseases and modern tumour therapy [22][23][24]. Thus, the potential use of moxifloxacin for antibiotic prophylaxis is brought into focus.…”

Pyogenic liver abscess in the elderly: What we have learned?

“…Therefore, they proposed that case fatality in older PLA patients was possibly related to host conditions, rather than to the characteristics of PLA itself. 11 In another large series of culture-confirmed PLA investigation, it was shown that malignancy and septic shock increased the mortality of PLA. 12 A previous nationwide study suggested that renal disease and malignancy correlated with higher death rates in all PLA patients.…”

“…In addition to K. pneumoniae, other causative agents such as E. coli and polymicrobial with or without anaerobic bacteria were also more frequently found in older patients. 11,12 Previous studies revealed that a high ratio of hepatobiliary malignancy was found in non-K. pneumoniae patients. 8 Physicians should pay attention to the associated malignancy in geriatric PLA patients, which can lead to a poor prognosis.…”

“…1 It is noteworthy that there was no significant difference in frequency of DM between the different age groups, which is also consistent with that reported in the literature in Taiwan. 11,12 The current nationwide registry once again stressed the association between diabetes and liver abscess, regardless of age. However, diabetes could affect the neutrophil function by decreasing chemotaxis and phagocytosis and increasing the susceptibility of bacterial infections.…”

Imagerie des lésions infectieuses du foie

“…L'hyperphosphatasémie alcaline est l'élément le plus fréquent (90 % des cas). Les facteurs pronostiques péjoratifs sont : l'âge extrême du patient, avec une mortalité pouvant atteindre 80 % chez l'enfant et après 75 ans [3,4] ; les causes biliaires fréquemment compliquées d'abcès multiples ;…”