Liver abscess pathology and management in Western Sydney

Abstract

Background: Liver Abscesses (LA) are a highly morbid, life-threatening condition requiring prompt intervention. Pathologically they are grouped as Pyogenic (PLA), Amoebic (ALA), Hydatid (HLA) or Cryptogenic (CLA). This is the first analysis of LA in the changing population of Western Sydney. Methods: A retrospective analysis of data from 2012 to 2017 was conducted. Primary outcomes were incidence, pathogenicity, length of inpatient hospital stay (LOS), duration of antibiotic therapy (DABx) and mortality. Secondary Outcomes analysed included comorbidities, intervention types and rates, number of interventions, analysis of culture frequencies and concomitant disease. Results: A total of 133 patients were admitted with LA, average age 57 years (17–90) and 2.25:1 male predominance. The average annual incidence of 24 cases (range 19–29). The pathogenicity was 52% PLA, 16% ALA, 0% HLA and 16% CLA. Median stay was 11 days (range 1–98) and median DABx was 19 days (range 2–98). There were 19 (14%) readmissions and 5 (4%) mortalities. Comorbidities in the patient population included Diabetes 25%, Viral Hepatitis 8%, Immunosuppression 8%, IVDU 4%. Primary intervention was 18% antibiotic therapy only, 68% percutaneous drain insertion, 5% percutaneous aspiration and 8% operative intervention. 23(17%) required a second intervention, whilst 5% required a third. All were by percutaneous drainage. Overall operative intervention rate was 5%. PLA analysis of culture frequency was “K. pneumonia” 23% (30), “E. coli” 9% (12) and “S. anginosus” 8% (11). PLA concomitant biliary infection rate was 41% (55) and concomitant malignancy 18% (24); 9 primary liver (8 cholangiocarcinoma, 1 HCC) and 11 secondary malignancies. Conclusion: Liver abscess remains a rare condition despite the changing demographics of the Western Sydney region. Non-operative interventional drainage remains the mainstay of treatment.