Abstract
BackgroundThe role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter. The objective of this study was to evaluate the comparative effectiveness and safety of PNA combined with antibiotics.MethodsThis was a retrospective study of patients with PLA that were from 3 to 6 cm in diameter who treated at two medical centers in Shanghai, China, from January 2014 to March 2019. Patients were divided into groups treated by PNA plus antibiotics or antibiotics alone. Patients demographics and clinical data related diagnosis, antibiotic treatment, and patient outcomes were analyzed.ResultsOut of a total of 94 PLA patients, 42 (44.7%) patients received PNA combined with antibiotics, and 52 (55.3%) received antibiotics alone. There were no complications related to PNA. In the PNA group, 13 (31.7%) patients with negative blood culture and 8 (19.5%) patients without blood culture were microbiologically confirmed via aspiration. The time for temperature normalization (P < 0.001) and the reduction rate of C-reactive protein within the first week (P = 0.031) were significantly lower in the PNA group. In the multivariate analysis, treatment with PNA was more likely to result in clinical improvement of PLA (odds ratio = 0.33, 95% confidence intervals (CI): 0.11–0.96, P = 0.043).ConclusionsPNA combined with antibiotics appears to be a safe, effective, and promising treatment for PLA of 3–6 cm in size. Furthermore, the technique allows for direct microbial sample, which can improve the selection of antibiotics.
Highlights
The role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter
PLA is a potentially life-threatening disease associated with considerable morbidity and mortality
Several studies have shown that a combination of antibiotics and image-guided percutaneous treatment should be considered as first-line treatment for PLA because it achieves an equivalent curative rate with decreased trauma and cost, decreased morbidity, and decreased length of hospital stay [5,6,7,8,9,10,11,12,13,14]
Summary
The role of ultrasonography-guided percutaneous fine-needle aspiration (PNA) for pyogenic liver abscess (PLA) remains without consensus, especially in abscesses 3 to 6 cm in diameter. The objective of this study was to evaluate the comparative effectiveness and safety of PNA combined with antibiotics. PLA is a potentially life-threatening disease associated with considerable morbidity and mortality. Intravenous broad-spectrum antibiotics are the goldstandard for PLA treatment. Several studies have shown that a combination of antibiotics and image-guided percutaneous treatment should be considered as first-line treatment for PLA because it achieves an equivalent curative rate with decreased trauma and cost, decreased morbidity, and decreased length of hospital stay [5,6,7,8,9,10,11,12,13,14]
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