Transition to Oral versus Continued Intravenous Antibiotics for Patients with Pyogenic Liver Abscesses: A Retrospective Analysis

Abstract

Introduction The management of pyogenic liver abscesses usually requires 4 weeks of antibiotic therapy. It is unknown if oral (PO) antibiotics are as effective as intravenous (IV) antibiotics for this indication. Objectives To compare 30‐, 60‐, and 90‐day readmission rates between patients with pyogenic liver abscesses receiving IV antibiotics for the duration of therapy and those who were transitioned to PO antibiotics after discharge from the hospital. Methods This retrospective study included patients with pyogenic liver abscesses who had undergone percutaneous drainage and received IV antibiotics while in the hospital. Patients were grouped based on receipt of either PO or IV antibiotics at discharge. Results The final cohort resulted in 99 patients, 48 in the PO group and 51 in the IV group. The most common organisms identified were Klebsiella sp, Escherichia coli, and Streptococcus sp. The most common antibiotic received at discharge in the IV group was ertapenem or ceftriaxone plus metronidazole. Patients in the PO group most commonly received levofloxacin plus metronidazole at discharge. Thirty‐day readmission occurred more frequently in the PO group (PO 39.6% vs IV 17.6%, p=0.03). The most common reasons for readmission were complications related to abscess or antibiotic. Univariate logistic regression for readmission identified PO antibiotics at discharge as an independent predictor of readmission at 30 days (odds ratio [OR] 3.1), 60 days (OR 3.9), and 90 days (OR 3.1). Conclusion Transition to PO antibiotics that consisted mostly of fluoroquinolones for patients with pyogenic liver abscesses was associated with a higher rate of 30‐day readmission compared with patients treated with IV antibiotics that consisted mostly of β‐lactams.

Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess

“…The American Society of Infectious Diseases recommends intravenous antibiotics as first-line therapies for complicated intraabdominal infections [13]. The duration of therapy with intravenous antibiotics for patients with pyogenic liver abscess is generally 2-3 weeks, followed by 1-2 months of oral therapy [14,15]. The size of the liver abscess is usually used to determine whether image-guided needle aspiration, percutaneous catheter drainage, or surgical drainage should be performed.…”

Multiloculated Liver Abscess Caused by Fusobacterium: Role of Karius Testing in Diagnosis

“…A retrospective analysis done by Giangiuli et al demonstrated higher 30-day admission rates in patients who were transitioned to oral antibiotics, mostly quinolones, at time of discharge as compared to IV antibiotics, mostly beta-lactams, in PLA [7]. Mohan et al demonstrated sevenfold higher risk or colorectal cancer in patients with cryptogenic PLA.…”

Efficacy of empirical Ciprofloxacin or Cefixime plus Metronidazole therapy for the treatment of liver abscess: a randomized control clinical trial

“…According to the present study 2-3 weeks of oral antimicrobial therapy with or without percutaneous drainage/aspiration was adequate for the treatment of uncomplicated liver abscess. Further studies comparing the efficacy of empirical oral and intravenous antimicrobial for the treatment of liver abscess 20 , in a retrospective study of pyogenic liver abscess observed that, 30-day readmission rate was significantly higher in patients who received transition to oral (IV followed by oral) antibiotics (39.6% Vs 17.6%) than continued IV antibiotics. Whereas in present study overall only 5 participants required readmission, 3 participants had accidental slippage of PCD, 1 participant had new onset shock and 1 had new abscess formation.…”