Abstract
The standard therapeutic protocols of pyogenic liver abscess (PLA) have not been well established yet. We investigated the clinical characteristics, disease progression, choices of treatments and outcomes of PLA with different size. 410 cases of patients with PLA were enrolled retrospectively from 2000 to 2014, and were grouped as small abscess (≤5 cm, n = 125), large abscess (5 cm to 10 cm, n = 218) and giant abscess (>10 cm, n = 36). The most common bacteria were Klebsiella pneumonia (22%) and Escherichia coli (11%) by pus culture, and Escherichia coli (36.7%), gram-positive coccus,(36.7%) and Klebsiella pneumonia (33.3%) by blood culture. 115 patients (28.0%) received antibiotics treatment alone, 161 patients (39.3%) received percutaneous drainage (PD) and 134 patients (32.7%) underwent surgical incision and drainage (SD). The size of abscess was correlated with leukocytes increase, albumin decrease, and time duration for body temperature normalization (all p < 0.05). Antibiotics treatment alone, PD and SD was mainly used in patients with small abscess (42.4%), large abscess (44.0%) and giant abscess (47.2%), respectively. For patients with giant abscess, SD group (n = 17) had higher morbidity than PD group (n = 14) (76.4% vs. 35.7%, p = 0.022). PD might achieve the same curative rate as SD in giant abscess, but with less trauma, lower morbidity and shorter hospital stay.
Highlights
Pyogenic liver abscess (PLA) is a potentially life-threatening condition of hepatobiliary system infection, with mortality up to 19%1–3
Previous study has shown that abscess size greater than 7.3 cm predicted failure of Percutaneous drainage (PD), a recent study demonstrated that abscess greater than 10 cm could be successfully treated with PD, with a failure rate of 2.6%1
410 patients were enrolled into the present study from 2000 to 2014 in our hospital
Summary
Pyogenic liver abscess (PLA) is a potentially life-threatening condition of hepatobiliary system infection, with mortality up to 19%1–3. Intravenous use of antibiotics is considered as one of the most critical measure for treatment of PLA. Use of antibiotics is mostly effective in controlling symptoms of patients with small liver abscess. Effective drainage is recognized as the most effective treatment for large liver abscess, since it could definitely lower bacterial load and increase antibiotics penetration into the abscess[6]. Many surgeons advocated use of PD in abscess around 3–6 cm, and SD in abscess with larger size for complete drainage[7,8,9]. (e.g. antibiotics only, PD and SD) in abscess with different size during a 15-year period from the largest academic center and university affiliated hospital in Northwest China
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