Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics

Yi-Tsung Lin,Ping-Feng Wu,Chang-Phone Fung,Fu-Der Wang

doi:10.1186/1471-2334-13-56

Abstract

BackgroundKlebsiella pneumoniae liver abscess (KPLA) has been reported with increasing frequency in East Asian countries in the past 3 decades, especially in Taiwan and Korea. Diabetes is a well-known risk factor for KPLA and highly associated with septic metastatic complications from KPLA. We investigated the association of glycemic control in diabetic patients with the clinical characteristics of KPLA in Taiwan.MethodsAdult diabetic patients with KPLA were identified retrospectively in a medical center from January 2007 to January 2012. Clinical characteristics were compared among patients with different levels of current hemoglobin A1c (HbA1c). Risk factors for metastatic infection from KPLA were analyzed.ResultsPatients with uncontrolled glycemia (HbA1c ≥ 7%) were significantly younger than those with controlled glycemia (HbA1c < 7%). Patients with uncontrolled glycemia had the trend to have a higher rate of gas-forming liver abscess, cryptogenic liver abscess, and metastatic infection than those with controlled glycemia. Cryptogenic liver abscess and metastatic infection were more common in the poor glycemic control group (HbA1c value >; 10%) after adjustment with age. HbA1c level and abscess < 5 cm were independent risk factors for metastatic complications from KPLA.ConclusionsGlycemic control in diabetic patients played an essential role in the clinical characteristics of KPLA, especially in metastatic complications from KPLA.

Highlights

Klebsiella pneumoniae liver abscess (KPLA) has been reported with increasing frequency in East Asian countries in the past 3 decades, especially in Taiwan and Korea
One animal study of KPLA has suggested that diabetes might provide a specialized environment that allows K. pneumoniae strains to disseminate from the intestines into the blood [20]
Septic metastatic infection is highly associated with diabetic patients with KPLA; we analyzed the risk factors among these patients

Summary

Introduction

Klebsiella pneumoniae liver abscess (KPLA) has been reported with increasing frequency in East Asian countries in the past 3 decades, especially in Taiwan and Korea. Diabetes is a well-known risk factor for KPLA and highly associated with septic metastatic complications from KPLA. Since 1986, many researchers in Taiwan and several other areas have noted the distinctive syndrome of KPLA, complicated by bacteremia, sepsis, and metastatic infection of brain, eyes, lungs and other organs, especially in patients with diabetes [2,5,6,11,12,13,14,15]. Diabetes is a well-known risk factor for pyogenic liver abscess [17] and highly associated with KPLA [5,18,19]. Diabetes is the most common underlying disease among patients with septic metastatic complications from KPLA [12,13,19,21], and predisposes patients with KPLA to develop septic metastasis [22]. Compared with the monomicrobial cryptogenic noninvasive KPLA, cryptogenic KPLA with septic metastasis is characterized by an ~20-fold increased association with diabetes [23]

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Conclusion