Antibiotic Strategy for Pyogenic Liver Abscess: One Medical Center Experience in Taiwan

Abstract

Background and Aim: There is currently no consensus on antibiotic treatment for pyogenic liver abscess. This retrospective study intends to verify the equivalent effects between the step-up antimicrobial strategy and indiscriminate broad-spectrum antibiotic treatment for this disease. Methods: One hundred twenty-two consecutive patients with pyogenic liver abscess were retrospectively analyzed. In addition to abscess drainage, they were preferentially treated with a conservative regimen of parenteral antibiotics with cefazolin plus gentamicin at presentation. The mortality rate was compared with that of studies published in English-language medical literature. The complicated group, with mortality, metastatic infections, relapsed diseases, and involuntary surgeries, was compared with its contrary uncomplicated group to identify the risk factors for unfavorable clinical courses and outcomes. Results: The mortality rate was 10% (12/122), which was comparable to results documented in the English-language literature. There were 38 patients in the complicated group and 84 patients in the uncomplicated group. Seventy- three patients (60%) did not require modification of their cefazolin plus gentamicin regimen. Univariate analysis revealed that liver cirrhosis (OR=5.643, P=0.004), biliary disease (OR=3.440, P=0.006), pleural effusion (OR=3.556, P=0.003) and abscess rupture (OR=43.160, P=0.0001) were risk factors for complicated outcomes. Clinical jaundice (2.67±2.45 νs. 1.67±1.82 mg/dL, P=0.013) and anemia (11.6±2.43 νs. 12.53±1.88 g/dL, P=0.024) also reached the statistical significance. Multivariate logistic regression analysis revealed that liver cirrhosis (P=0.004), abscess rupture (P=0.0001) and biliary disease (P=0.0001) were independent risk factors. Conclusion: Cefazolin plus gentamicin suffices for most patients with pyogenic liver abscess. Liver cirrhosis, biliary disease, and abscess rupture are independent risk factors for a complicated disease course.