Abstract
BackgroundPyogenic liver abscess (PLA), although uncommon in North America, is associated with significant morbidity and mortality. We sought to re-examine the epidemiology, risk factors, and outcomes of PLA in a large, diverse Canadian health zone.MethodsAll Calgary Health Zone (CHZ) residents aged ≥20 with PLA between 2015 and 2017 were identified. Incidence and mortality rates were calculated using census data. Risk factors for PLA were identified using a multivariate analysis. Data was compared to 1999–2003 data, also collected in the CHZ.ResultsThere were 136 patients diagnosed with PLA between 2015 and 2017. Incidence rate during this period increased significantly relative to 1999–2003 (3.7 vs 2.3 cases/100,000 population, p < 0.01), however, mortality rates remained similar. The microbiological composition of PLA did not change over this 15-year time period but the number of antimicrobial resistant isolates did increase (8% vs 1%, p = 0.04). The greatest risk factors for PLA relative to general populations included current malignancy, liver-transplant, end-stage renal disease, and cirrhosis. Thirty-day mortality was 7.4% and independent risk factors included polymicrobial bacteremia, absence of abscess drainage, congestive-heart failure, a history of liver disease, and admission bilirubin.ConclusionsPyogenic liver abscess is a health concern with rising incidence rate. The increasing prevalence of comorbidities in our population and factors that are associated with risk of PLA suggests this will continue to be an emerging diagnosis of concern. Increasing prevalence of antibiotic resistant organisms compounding unclear optimal treatment regimens is an issue that requires urgent study.
Highlights
Pyogenic liver abscess (PLA), uncommon in North America, is associated with significant morbidity and mortality
Data sources Study subjects were identified using the International Classification of Diseases 9 and 10 (ICD-9 & ICD-10) codes for hospitalized individuals diagnosed with PLA and cross referenced to the Calgary Laboratory Services (CLS) database to identify all microbiological specimens taken from liver aspirations
Similar to 15-years ago, incidence rate of PLA was higher among males compared to females (4.7 vs 2.7/100,000 population between 2015 and 2017, rate ratios (RR) = 1.74 (1.08–2.79 95% confidence intervals (CI)), p = 0.01)
Summary
Pyogenic liver abscess (PLA), uncommon in North America, is associated with significant morbidity and mortality. Pyogenic liver abscess (PLA) is a significant health concern, with highest incident rates reported in Asia. These abscesses can develop from; (i) biliary tree pathology (e.g. ascending cholangitis), (ii) ascending gastrointestinal tract infections via the hepatic portal vein, (iii) systemic bacteremia. Within a Canadian population the Streptococcus anginosus group (44%), Klebsiella species (27%), anaerobes (20%), and Escherichia coli (16%) were cultured most frequently [3]. Multiple studies from Taiwan and other parts of Asia have found Klebsiella species to be most common (approximately 68–79% of cultured organisms) with increasing concern about the prevalence of extended spectrum beta-lactamase (ESBL) producing species as well as hypervirulent mucoviscous strains [7, 8]
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