Outcomes of gas-forming pyogenic liver abscess in the era of multimodal care

Abstract

Introduction: Gas-forming pyogenic liver abscess (GfPLA) represents 7-24% of all pyogenic liver abscess (PLA) cases. It is associated with higher mortality compared to non-gas-forming PLA. Provision of integrated multimodal care can improve outcomes. We aim to evaluate the outcomes of GfPLA in the era of multimodal care. Methods: A retrospective analysis of all patients with PLA treated at a tertiary hospital from 2007 to 2011. GfPLA is defined when gas locules are detected on index imaging (CT or Ultrasound). Demography, clinical profile and outcomes were studied and reported. SPSS version 17 was used for data analysis. Results: 213 patients were treated for PLA from 2007-2011. 41 (19.2%) patients had GfPLA. Mean age of patients was 60 years old (range 25–89). Majority of patients with GfPLA presented with nonspecific constitutional symptoms (95%) and fever (78%). 12.2% of patient with GfPLA had septic shock compared to only 5.8% in non-gas-forming group. The most prevalent causative organism was Klebsiella pneumoniae (81%) for GfPLA. Mean size of GfPLA was 6.62 cm ( ranged from 2.6 to 10.9 cm ) Significantly more GfPLA patients (30 out of 41 = 73%) had percutaneous drainage compared to 53.5% in non-gas-forming group.( p = 0.02) Overall 30-day mortality for GfPLA and non-gas-forming PLA was 9.8% and 13.95% respectively (p = 0.475). Conclusion: High index of clinical suspicion is important for early diagnosis of GfPLA in view of non-specific clinical presentations. Outcomes of GfPLA are similar to non-gas forming PLA in the setting of multimodal care.