Pyogenic liver abscesses with Klebsiella pneumoniae in a public hospital in Queens, New York

Abstract

Introduction Klebsiella pneumoniae liver abscesses have become more common in US hospitals, based upon the demographics of the population served. Methods We reviewed laboratory and clinical data for patients admitted to Elmhurst Hospital, New York from 2000 to 2007. Results Of the 56 cases of pyogenic liver abscesses reviewed, twenty (35.7%) were secondary to Klebsiella pneumoniae , verified via radiographic imaging plus positive blood culture or liver aspiration culture. Liver drainage appeared to be the most important aspect for treatment. The mean age of the patients was 56.5 years. Fourteen (70%) were male. Twelve patients (60%) were of Asian descent. Hypertension was found in 9(45%) of the patients, diabetes mellitus and biliary disease were found in 5(25%) each, no medical history found in 4(20%). Solitary abscess was found in 16(80%) of patients, 15 of those in the right hepatic lobe. Of the 4(20%) with multiple abscesses, 2 were in the right hepatic lobe, and 2 in the left hepatic lobe. Positive blood culture was found in 65% and positive liver abscess culture in 70%. Eight patients had both positive blood cultures and positive liver abscess cultures (40%). Four patients experienced metastatic infection to the lungs (20%), and only one patient developed meningitis, bilateral endophthalmitis, and pneumonia. Fifty per cent of patients received an infectious diseases consult. All of these cases were treated with ceftriaxone. The mean duration of intravenous antibiotics for these patients was 23.9 days. The mean duration of antibiotics for patients without an infectious diseases consult was 12.2 days. Discussion The majority of Klebsiella pneumoniae liver abscesses occurred in patients of Asian descent, many without any risk factors. Choice of antibiotics and length of treatment varied depending upon whether an infectious disease consult was called or not. Patient demographics should be kept in mind in patients with liver abscesses.