1099 Epidemiology and Diagnostic Evaluation of Patients With Liver Abscesses at an Academic Hospital in Washington, DC

Abstract

INTRODUCTION: Liver abscesses often requires a multidisciplinary approach involving infectious diseases (ID), radiology, gastroenterology (GI) and occasionally surgery. Since there are no clinical guidelines for liver abscess management, regional epidemiology is important to refine management of these infections. This study reviewed the epidemiology, source evaluation and management of patients with liver abscesses in Washington, DC. METHODS: We performed a retrospective review of patients diagnosed with liver abscesses at our institution from 2012 through 2018. We reviewed patient demographics, predisposing conditions, abscess microbiology, hospital care and post-discharge management. RESULTS: 105 patients were identified (mean age 57.1 years old, 62.9% men). 57.1% were African American (AA), 22.9% Caucasian, 7.6% Hispanic, 7.6% Asian, and 4.7% other races. 42.9% of patients had underlying risk factors including diabetes (21.9%), inflammatory bowel disease (4.8%), human immunodeficiency virus (3.8%), intravenous drug use (3.8%) and trauma (8.6%). 18.1% had known intraabdominal cancers (7 colonic, 5 pancreatic, 3 duodenal, 3 cholangiocarcinoma, and 1 ovarian). All patients underwent computed tomography, 52.4% ultrasound, 18.1% magnetic resonance imaging, and 6.7% MRCP. Abscess intervention was performed in 73.3% of patients. 56.7% of abscesses were monomicrobial and 43.3% polymicrobial. Cultures grew primarily Gram negatives (43%), followed by Gram positives (36.8%), anaerobes (11.4%), yeast (6.1%), and parasites (2.6%) (Figure 1). Blood cultures were positive in 41.9% of cases. ID was consulted in 68.6% of cases, while GI in only 39%. 23 patients underwent an inpatient procedure (14 ERCPs, 9 colonoscopies) with AA patients having statistically more ERCPs (21.7% vs 2.2%, P < 0.01). A source was identified in 69.2% of cases, with 32.4% having a biliary source. Those >50 years old were significantly more likely to have biliary disease than those < 50 years old (38.9% vs 18.2%, P < 0.05). When no source was identified, only 21.9% (7/32 patients) had outpatient GI follow up for further evaluation. CONCLUSION: Liver abscesses remain relatively uncommon. GI is not consulted in the majority of cases. Of concern is that a significant number of patients have no etiology identified and the majority of these do not get an appropriate outpatient evaluation. More frequent inpatient GI consultation, particularly for patients with no identifiable source, should be considered.