Abstract
Background Klebsiella pneumoniae is the most common pathogen of community-acquired pyogenic liver abscess in East Asia. Diabetes mellitus (DM) is a well-established risk factor for K. pneumoniae liver abscess (KPLA). However, reports regarding the emergence of KPLA in non-diabetic patients are limited.ResultsA total 230 patients with KPLA from a medical center in Taiwan were identified retrospectively. The rate of DM in patients with KPLA was 44.4 % in 2011, 57.9 % in 2012, 44.9 % in 2013, 35.0 % in 2014, and 53.5 % in 2015. Diabetic patients had higher rate of gas-forming abscesses than non-diabetic patients, but the clinical outcomes were not different. The six virulent capsular types (K1, K2, K5, K20, K54, and K57) accounted for 90.2 % of all K. pneumoniae isolates, and were more prevalent in non-diabetic than diabetic patients (93.9 vs 85.9 %, P = 0.048). The six virulent capsular types were also more prevalent in the group with optimal glycemic levels (Non-DM and DM with HbA1c level <7 %) than the DM group with HbA1c level ≥7 % (93.9 vs 84.3 %, P = 0.022).Conclusion Klebsiella pneumoniae liver abscess has emerged in non-diabetic patients in Taiwan. Diabetic patients were at higher risk of acquiring gas-forming abscesses. Non diabetic patients and diabetic patients with optimal glycemic levels are more susceptible to the virulent capsular types of K. pneumoniae.
Highlights
Klebsiella pneumoniae is the most common pathogen of community-acquired pyogenic liver abscess in East Asia
We aimed to investigate the clinical characteristics of K. pneumoniae liver abscess (KPLA) patients and the associated capsular types of K. pneumoniae strains in Taiwan in the recent 5 years
Clinical characteristics of KPLA in patients with or without Diabetes mellitus (DM) A total of 255 patients diagnosed with KPLA during the study period were enrolled. 25 patients were excluded: 6 patients were infected by multidrug-resistant K. pneumoniae nosocomially, 6 patients developed a liver abscess after trans-hepatic arterial chemoembolization for hepatocellular carcinoma, 1 patient developed a liver abscess after replacing a stent over common bile duct, and 12 patients had polymicrobial liver abscess
Summary
Klebsiella pneumoniae is the most common pathogen of community-acquired pyogenic liver abscess in East Asia. Diabetes mellitus (DM) is a well-established risk factor for K. pneumoniae liver abscess (KPLA). Reports regarding the emergence of KPLA in non-diabetic patients are limited. In the past three decades in East Asian countries (especially Taiwan, Korea, and Singapore), K. pneumoniae has emerged as the major cause of community-acquired pyogenic liver abscess [7,8,9,10,11,12,13,14,15]. We reported that diabetic patients with uncontrolled glycemia were more susceptible to metastatic complications from KPLA than those with controlled glycemia [11]. The relationship between the capsular types of K. pneumoniae and different glycemic status of patients with KPLA remains undetermined
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