A91 PYOGENIC LIVER ABSCESSES DUE TO FUSOBACTERIUM NUCLEATUM ARE ASSOCIATED WITH SEVERE INFLAMMATORY RESPONSE AND ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Abstract Background Pyogenic liver abscesses (PLAs) are uncommon entities with potentially devastating consequences requiring early diagnosis and treatment. Fusobacterium nucleatum is an anaerobic, gram-negative bacterium that is a rare cause of liver abscesses. F. nucleatum initiates a severe pro-inflammatory cascade that promotes abscess formation through the gut-liver axis especially when the gastrointestinal (GI) barrier is compromised. Aims In this study, we explore the characteristics of PLAs due to F.nucleatum, including the duration and mode of therapy. This may inform clinical decisions when treating persons with suspected F.nucleatum PLAs and improve mortality. Methods A systematic literature search was conducted in MEDLINE, PubMed, and the Cochrane Library, from 1977 to September 2023. We included full-text abstracts and articles written in English that reported patients with F.nucleatum PLA aged ampersand:003E18. Demographics, history of GI diseases, pertinent laboratory markers, abscess characteristics, and the approaches taken to treat the abscess were collected. Pooled data were assessed qualitatively and reported as mean±SEM when appropriate. Results We included 32 studies. The mean patient age was 52±20 years with 71% being male. In total, 47% of patients had a recent history of GI disease: sigmoid diverticulosis (n=6), colonic adenomas (n=5), duodenitis (n=2), appendicitis (n=1) and ulcerative colitis (n=1). On presentation, only 53% (n=17) reported abdominal pain. Labs were significant for leukocytosis at 22±2 K/µL, C-reactive protein 199±37 mg/L, aspartate transferase (AST) 128±24 U/L, alanine aminotransferase (ALT) 116±16 U/L, Alkaline phosphatase (ALP) 275±35 IU/L, and bilirubin 11±3 mg/dL suggestive of severe inflammatory response and cholestatic liver injury. The average abscess size was approximately 10.2±0.7 cm, 28% of which had loculations (n=9) requiring multiple drainages (n=7) or laparoscopy (n=2). The initial antibiotic of choice was piperacillin/tazobactam (Zosyn) (n=12), ceftriaxone + metronidazole (n=7), Ampicillin/Sulbactam (Unasyn) (n=5), followed by Meropenem, Metronidazole, and Ciprofloxacin. The estimated length of stay was 23±4 days with a need for long-term antibiotic therapy (54±10 days) upon discharge. The majority of patients were discharged on Metronidazole (n=11), or Amoxicillin/Clavulanic acid (Augmentin) (n=6). With appropriate source control, the estimated survival was 91% (n=29). Conclusions Our findings suggest that PLAs due to F.nucleatum are associated with large abscesses, a severe inflammatory response, cholestatic liver injury, and prolonged hospitalization. Multiple drainages with targeted gram-negative coverage may be required for adequate source control and favorable outcomes. Funding Agencies None