Management Of Pyogenic Liver Abscess Research Articles

Characteristics and Management of Pyogenic Liver Abscess: A Rural Senegalese Experience

Background: The incidence of pyogenic liver abscess (PLA) has increased in recent years with the development of digestive surgery, particularly hepatobiliary surgery. In recent decades, progress in diagnostic techniques have improved patient prognosis. In Senegal, there are few studies of PLA. This study was carried out within this context.
 Objective: The main objective was to describe the profile and the management of pyogenic liver abscesses cases in rural Senegal.
 Results: We collected 17 cases of PLA among 47.553 patients, during the study period, representing a hospital frequency of 0.035%. The mean age of patients was 48.6 ± 18.9. The sex ratio (M/F) was 2:4. Most of the patients (58.82%) had at least one risk factor, the main ones being smoking, a history of abdominal surgery and alcoholism. Right upper abdominal pain was the main reason for consultation (94.11%). Right basithoracic pain and cough were the most frequent respiratory symptoms. Escherichia coli remained the most frequently isolated bacteria. The mean time to diagnosis was 17.8 days ± 14.4. All patients received antibiotic therapy, which was combined with echo-guided liver aspiration in 58.82% cases. Mean hospital stay was 17.5 days ± 7.65. The hospital lethality rate was 29.41%.
 Conclusion: Liver abscesses are most often of amoebic origin in our context, but in recent years there has been an increase in cases of pyogenic liver abscesses, with the progress made in diagnosis.

Management of Pyogenic Liver Abscesses: Contemporary Strategies and Challenges.

Pyogenic liver abscesses (PLAs) are a suppurative infection of the hepatic parenchyma responsible for significant morbidity and mortality. PLAs are categorized into a variety of mechanisms: (1) via the portal vein, (2) through the biliary tract, (3) via the hepatic artery, (4) from trauma, (5) contiguously via direct extension, and (6) cryptogenically. The pathogenesis of PLA, which informs treatment, can often be discerned based on host factors, clinical presentation, and causative microorganisms. The Streptococcus anginosus group, hypervirulent Klebsiella pneumoniae , and multidrug-resistant gram-negative pathogens have emerged as microbiologically challenging organisms to treat. The identification of hypervirulent K. pneumoniae should prompt for assessment for metastatic spread and consideration of prolonged antimicrobial treatment. Abdominal imaging is indispensable in characterizing PLAs and facilitating source control interventions. Source control remains the most critical aspect of PLA management, followed by antimicrobial therapy. Empiric antibiotics for PLAs are informed by the suspected etiology of PLA formation. Duration of antimicrobial therapy is individualized and dependent on multiple components, including the success of achieving source control, host factors, mechanism of PLA development, and the illness course of the individual-factoring in clinical, biochemical, and radiographic parameters.

Increasing incidence of pyogenic liver abscess in Southern Sweden: a population-based study from 2011 to 2020

Background Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease, and estimates suggest a gradual increase in the incidence during the last decades. The primary aim of this study was to report the incidence, trend and aetiology of PLA during a decade in Southern Sweden. Methods This was a population-based observational cohort study between 2011 and 2020 in Skåne, Southern Sweden. Data were retrieved from the Swedish National Board of Health and Welfare for all individuals diagnosed with liver abscess (K750) according to ICD-10 (International Statistical Classification of Diseases, 10th revision). Results A total of 456 episodes of PLA occurred in 364 patients during the study period. The median age of the first PLA episode was 71 years (range 3–97) and 57% (n = 206) were men. The mean incidence of all patients was 3.4/100,000 person-years (range 1.8–5.2). The incidence increased almost three times, from 1.8/100,000 person-years in 2011 to 5.2/100,000 person-years in 2020. Streptococcus species, Escherichia coli and Klebsiella species accounted for the vast majority of both mono- and polymicrobial findings in both blood and local abscess cultures. 16s rDNA added information about aetiology in 37% of episodes. Conclusion The incidence of PLA increased during the study period, and Streptococcus spp., Klebsiella spp. and E. coli dominated both blood and local cultures. Despite antimicrobial therapy, pathogens could be found in local abscess cultures several weeks into treatment. Increased use of 16s rDNA in the management of PLA could be beneficial.

Pyogenic Liver Abscess: Contemporary Trends in a Tertiary Institute.

Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening condition. In recent years, advances in diagnostics and management have led to early diagnosis and treatment and decreased mortality. We present recent data from a large series of patients with PLA and examine the trends in the management of PLA over a period of 50 years. The medical records of all patients admitted to the Shaare Zedek Medical Center, Israel, between January 2011 and December 2021 with a primary or secondary diagnosis of PLA were reviewed retrospectively. : Ninety-five patients with PLA were identified. Thirty-eight (40%) were female. The median patient age was 66 years (range 18-93). The diagnosis of PLA in all patients was confirmed with abdominal computed tomography (CT). In twenty patients (21.1%), PLA was not diagnosed by the initial abdominal US. Most abscesses were right-sided. Biliary tract origin was the most common underlying cause of PLA (n = 57, 60%), followed by cryptogenic etiology (n = 28, 30%). Escherichia coli, Klebsiella pneumoniae, and Streptococcus species were most commonly identified. The most common primary treatment modality was percutaneous drainage (PD), which was performed in 81 patients (85.3%). Fourteen patients (14.7%) were treated medically without intervention, and two patients (2.1%) were treated surgically following a failure of PD. Four patients died as a direct result of PLA. Patients diagnosed with PLA are older, the male predominance is less pronounced, and the offending pathogens are likely to originate from the biliary tract. This study questions the utility of abdominal US as the initial diagnostic imaging in patients with suspected PLA (versus CT) and demonstrates improved outcomes for patients with PLA over the years.

Pyogenic liver abscess: contrast-enhanced ultrasound allows morpho-evolutive classification and guides personalized management

Aim: The aim of this study is to propose a contrast-enhanced ultrasound (CEUS)-based morphologic classification of pyogenic liver abscess (PLA) reflecting different evolutive stages and to assess the added value of CEUS in the management of PLA. Methods: Forty-four PLAs of different etiologies in 44 patients (male/female = 24/20; mean age 66 ± 14.7 years) were evaluated with ultrasound (US) B-mode and CEUS (using SonoVue). PLAs were mainly located in the right lobe (n = 28, 63.6%) with a mean diameter of 6.8 cm [standard deviation (SD) ± 3.2, range 1.7–15 cm]. Conventional US findings were categorized as the presence and extension of liquified areas, echogenicity and echostructure of the index lesion. Peripheral hyperenhancing rim, transient segmental enhancement, hyperenhancing septa and “honeycomb” aspect were considered PLA hallmarks in the arterial phase after contrast agent injection. CEUS results were judged as clinically relevant if they modified the approach to percutaneous treatment in comparison with pre-operative US B-mode findings. Results: CEUS was superior to US B-mode as to depiction of PLA internal echostructure and enabled identification of 4 evolutive stages of PLA: type I (tumor-like), type II (“honeycomb”), type III (multiloculated with incomplete septa), and type IV (cystic-like). In 22 cases (67.4%) out of 34 who underwent percutaneous treatment, the operator tailored percutaneous approach according to PLA internal echostructure observed during CEUS exam. Conclusions: CEUS depicts the internal structure of PLA so allowing a morpho-evolutive classification of PLA and provides invaluable information for immediately tailoring the management to the single case. By showing the structure of PLA more precisely, CEUS allows a morpho-evolutive PLA classification and guides tailored management in the single case.

S3657 Delayed Presentation of Pyogenic Liver Abscess Following an Appendectomy

Introduction: Historically, appendicitis was a common cause of pyogenic liver abscess (PLA), however, antibiotics and early surgical intervention have improved outcomes. This case depicts a delayed presentation of liver abscess secondary to perforated appendicitis. Case Description/Methods: A 34-year old male presented with a 2-week history of right upper quadrant pain, 4 days of fever with chills, nausea, and vomiting. Six months ago he had a perforated appendix with a subsequent appendectomy. He denied any alcohol use, illicit drug use, and recent travel. Vitals revealed a temperature of 101.1°F, HR of 112, and SBP fluctuating from 70-90 mmHg. Labs were significant for WBC 18.2, AST 50, ALT 66, ALP 255, TBILI 1.0, INR 1.64, PT 18.5, PTT 30.7, and lactate 3.4. A CT of the abdomen without contrast demonstrated a 6.0 x 9.0 cm bilobed lesion in the right lobe of the liver suspicious for hepatic abscess. The abscess was percutaneously drained and cultures grew moderate E. coli and many Bacteroides fragilis with stool ova/parasite positive for Blastocystis hominis. Based on antimicrobial sensitivity the patient was discharged on ciprofloxacin and metronidazole. On outpatient follow-up, repeat imaging showed that the abscess had decreased in size to 3.0 x 3.0 cm and was responding to antibiotic treatment and drainage. Discussion: Appendicitis was previously one of the most common etiologies for liver abscesses, however with better diagnostic and treatment modalities for appendicitis, it is seldom considered. PLA is defined as one or more discrete lesions in the liver associated with a positive bacterial culture and accounts for 48% of all visceral abscesses in the US. PLA is usually due to polymicrobial infections, most commonly E. coli and Klebsiella but may also include Streptococcus, Staphylococcus, and anaerobes. Risk factors include male gender, advanced age, diabetes, chronic PPI use, malignancy, cirrhosis, and liver transplant history. Liver abscesses are most commonly found in the right lobe of the liver due to receiving venous drainage from the cecum and ascending colon. Screening colonoscopy should be considered when there are cultures with anaerobic growth as anaerobic abscesses are associated with silent colon cancer. In-hospital mortality for PLA is estimated to range between 2.5-19%. Management of PLA is largely dependent on the size of the abscess. Antibiotic use is the treatment of choice for small abscesses of < 3-5 cm, while anything larger also requires percutaneous or surgical drainage.Figure 1.: CT abdomen pelvis without IV contrast demonstrated a 6.0 x 9.0 cm bilobed lesion in the right lobe of the liver suspicious for hepatic abscess.

Management of pyogenic liver abscess: a South Australian experience.

There have been declining mortality rates associated with pyogenic liver abscess (PLA) in recent decades due to improvements in percutaneous drainage techniques, access to imaging and improvements in supportive care. The aim of this study was to analyse the aetiology, management and outcome of PLA at a tertiary hospital in Adelaide. Data was collected retrospectively from 80 patients who were admitted with a PLA between 2011 and 2018. The data points covered demographic variables, presumed aetiology, microbiology results, abscess imaging characteristics, interventions, antibiotic treatment, complications and mortality. The majority of patients were Caucasian (86%) and the most common predisposing conditions were biliary tract disease (39%), intra-abdominal infection (20%) and diabetes (18%). Escherichia coli (21%), Klebsiella species (18%), Streptococcus anginosus group (14%) and anaerobes (18%) were the most frequent pathogens isolated. Fifty-one percent of patients were bacteraemic. Percutaneous catheter insertion (45%) was the most common form of drainage followed by percutaneous aspiration (13%), surgery (11%) and endoscopic retrograde cholangiopancreatography (6%), while 25% of patients did not undergo any form of drainage. Twenty-four patients (30%) suffered a complication with the highest proportion occurring in the medically managed group. The overall mortality rate was 9% with only 1% mortality rate attributable to PLA. This study demonstrates a continued preference for percutaneous drainage techniques over surgery in the management of PLA. A significant proportion of patients did not undergo abscess drainage and the risk of subsequent complications appeared to concentrate in this group, although the mortality rate from PLA was low.

Risk Factors, Management, and Outcomes of Pyogenic Liver Abscess in a US Safety Net Hospital.

The causes and management of pyogenic liver abscess (PLA) have undergone multiple changes over the past decades. It is a relatively rare disease in the USA, and its incidence rate in the USA is increasing. The last US community hospital experience of PLA was published in 2005. We performed a retrospective study of patients admitted with PLA to an urban safety net hospital. To ascertain risk factors, management approaches, and outcomes of PLA. Electronic medical record was queried for diagnosis codes related to PLA during the years 2009-2018. Clinical information was compiled in an electronic database which was later analyzed. Main study outcomes were in-hospital mortality, 30-day readmission rate, and intensive care utilization rate. A total of 77 patients with PLA were admitted in the study period. Most common risk factors were diabetes mellitus (23.4%), previous liver surgery (20.7%), and hepatic malignancy (16.9%). 89% of patients were treated with percutaneous drainage or aspiration, and surgical drainage was reserved for other with other indications for laparotomy. In-hospital mortality, 30-day readmission, and intensive care utilization rates were 2.6%, 7% and 22%, respectively. Median length of stay was 11days (inter-quartile range 7). Rate of antimicrobial resistance in abscess fluid cultures was 40%; 13 cases of Klebsiella pneumoniae liver abscess were noted in our cohort, most of whom were Hispanic or Asian. PLA was principally managed by percutaneous drainage or aspiration with good outcomes. Further studies investigating the racial predilection of K. pneumoniae liver abscesses could reveal clues to its pathogenesis.

Transition to Oral versus Continued Intravenous Antibiotics for Patients with Pyogenic Liver Abscesses: A Retrospective Analysis.

The management of pyogenic liver abscesses usually requires 4 weeks of antibiotic therapy. It is unknown if oral (PO) antibiotics are as effective as intravenous (IV) antibiotics for this indication. To compare 30-, 60-, and 90-day readmission rates between patients with pyogenic liver abscesses receiving IV antibiotics for the duration of therapy and those who were transitioned to PO antibiotics after discharge from the hospital. This retrospective study included patients with pyogenic liver abscesses who had undergone percutaneous drainage and received IV antibiotics while in the hospital. Patients were grouped based on receipt of either PO or IV antibiotics at discharge. The final cohort resulted in 99 patients, 48 in the PO group and 51 in the IV group. The most common organisms identified were Klebsiella sp, Escherichia coli, and Streptococcus sp. The most common antibiotic received at discharge in the IV group was ertapenem or ceftriaxone plus metronidazole. Patients in the PO group most commonly received levofloxacin plus metronidazole at discharge. Thirty-day readmission occurred more frequently in the PO group (PO 39.6% vs IV 17.6%, p=0.03). The most common reasons for readmission were complications related to abscess or antibiotic. Univariate logistic regression for readmission identified PO antibiotics at discharge as an independent predictor of readmission at 30 days (odds ratio [OR] 3.1), 60days (OR 3.9), and 90 days (OR 3.1). Transition to PO antibiotics that consisted mostly of fluoroquinolones for patients with pyogenic liver abscesses was associated with a higher rate of 30-day readmission compared with patients treated with IV antibiotics that consisted mostly of β-lactams.

Contemporary Surgical Management of Pyogenic Liver Abscess

Contemporary Surgical Management of Pyogenic Liver Abscess

Management of pyogenic liver abscesses in single hospital over 5 year period

Management of pyogenic liver abscesses in single hospital over 5 year period

The utility of CA 19-9 in the management of pyogenic liver abscess

Introduction: CA 19-9, a well-known tumor marker in gastro-intestinal malignancies, is also elevated in benign conditions like acute cholangitis, chronic liver disease etc. Its elevation in liver abscess is rarely reported. Methods and results: A 71-year-old male, a known diabetic and coronary artery disease, presented with breathlessness for 3 days. He had leukocytosis and bilobar cannon-ball lesions on chest radiograph. HRCT chest revealed bilateral patchy lung consolidation and a 8x6cms liver abscess in right lobe(Figure 1). His CA 19-9 was 747 while AFP and CEA were normal. His clinical diagnosis was intrahepatic cholangiocarcinoma with secondarily infected necrosis. He rapidly developed multi-organ failure and managed with mechanical ventilation, inotropes, hemodialysis and antibiotics. Percutaneous drainage in 2nd week revealed thick pus. CA 19-9 increased to 922 and 1198 in 2nd and 3rd weeks. Multiple percutaneous drains achieved adequate drainage by end of 3rd week. CA 19-9 fell thereafter to 667, 130 and 108 at 4, 6 and 10 weeks respectively. Trucut biopsy of the lesion and colonoscopy did not reveal any malignancy. He gradually recovered and was discharged after 10 weeks stay. At 2 months follow-up, the patient is fine with CA 19-9 of 24, with a residual 2 x 2 cms liver cavity and complete resolution of lung lesions on imaging. Conclusion: CA 19-9 elevation in liver abscess is probably common and does not mean a co-existing malignancy. It can be biochemical marker of abscess resolution and can be used in the follow-up.

Characteristics and management of pyogenic liver abscess: A European experience.

Pyogenic liver abscess (PLA) are space-occupying lesions in the liver associated with high morbidity and mortality. The aim of this study is to review an Italian hospital experience in epidemiological, clinical patterns, and management of PLA.We performed a retrospective, descriptive case series at a single center assessing demographic characteristics, presentation patterns, etiological factors, microbiological etiology, and management for patients treated for PLA between 2000 and 2016.Around 109 patients were identified. The majority of patients presented with fever (73%); right upper abdominal pain in 63.3%, vomiting and nausea in 28.4%. The most common laboratory abnormality among included items was increased C-reactive protein and fibrinogen blood levels, respectively, in 98% and 93.9% of cases. Abdominal ultrasound was the diagnostic investigation in 42.4% of cases; CT scan and MR imaging were performed in 51.1% and 3.3% of cases respectively. We observed blood or pus culture study in 99 cases of which only 53.5% came with positive microbial reports. The most common organism identified was Escherichia coli (26.5%), followed by Streptococcus spp (13.2%). Early antibiotic treatment started on all patients and 66.7% of cases required different approaches, Ultrasound or CT-guided needle aspiration of PLA was performed in 13 patients (11%) and percutaneous abscess drainage was performed on 72 patients (67%).PLA is a diagnostically challenging problem due to nonspecific presenting characteristics. The microbiological yield identified was a typical European spectrum with a preponderance of Escherichia coli infections. Once recognized, percutaneous drainage and antibiotic treatment are the mainstay of management for PLA.

Computed tomography-guided catheter drainage with ozone in management of pyogenic liver abscess.

PurposeTo compare the treatment efficacy of percutaneous catheter drainage alone to catheter drainage combined with ozone in the management of pyogenic liver abscess (PLA).Material and methodsThis prospective study included 85 patients diagnosed with PLA. All patients were randomly divided into two groups: catheter drainage alone (Group I); catheter drainage combined with ozone (Group II). Drainage was considered successful when: 1) the abscess cavities were completely drained, and 2) clinical symptoms were resolved. Kruskall-Wallis nonparametric test was used to compare the success rates, length of stay (LOS), and need of further surgery. A value of p < 0.05 was considered significant for all statistical analyses.ResultsIn all the patients’ percutaneous catheters were placed successfully under the guidance of computed tomography. All of the patients in Group I (43; 50.6%) were treated with percutaneous catheter drainage alone, while the patients in Group II (42; 49.4%) were treated with PCD combined with ozone. The success rates of Group I and II were 81% and 94%, respectively (p < 0.05). The duration of fever as well as LOS was longer for Group I when compared with Group II (p < 0.05).ConclusionsCatheter drainage combined with ozone is an effective and safe treatment in PLA.

Patients with culture negative pyogenic liver abscess have the same outcomes compared to those with Klebsiella pneumoniae pyogenic liver abscess

Etiologic organism is not frequently isolated despite multiple blood and fluid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogenic liver abscess (CNPLA) is routinely managed by antibiotics targeted to Klebsiella pneumoniae. In this study, we evaluated the outcomes of such clinical practice. All the patients with CNPLA and Klebsiella pneumoniae PLA (KPPLA) admitted from January 2003 to December 2011 were included in the study. A retrospective review of medical records was performed and demographic, clinical and outcome data were collected. A total of 528 patients were treated as CNPLA or KPPLA over the study period. CNPLA presented more commonly with abdominal pain (P=0.024). KPPLA was more common in older age (P=0.029) and was associated with thrombocytopenia (P=0.001), elevated creatinine (P=0.002), bilirubin (P=0.001), alanine aminotransferase (P=0.006) and C-reactive protein level (P=0.036). CNPLA patients tend to have anemia (P=0.015) and smaller abscess (P=0.008). There was no difference in hospital stay (15.7 vs 16.8 days) or mortality (14.0% vs 11.0%). No patients required surgical drainage after initiation of medical therapy. Despite demographic and clinical differences between CNPLA and KPPLA, overall outcomes are not different.

Fever Through a Jaundiced Eye.

Pyogenic liver abscess (PLA) is an important clinical entity to consider in a patient with fever and abdominal pain. Previously, the condition was difficult to diagnose and treat, but with the introduction of widely available and reliable imaging techniques, its diagnosis has become more straightforward. Although uncommon, PLA should especially be considered in the differential diagnosis for patients with specific predisposing conditions such as underlying biliary tract disease, whether as a result of chronic inflammatory disease or malignancy. The introduction of percutaneous drainage has revolutionized the management of PLA, and thus, this disease has become largely correctable.

Presentation and Management of Pyogenic Liver Abscess in Surgery Department: About 34 Cases

AIM: To describe the clinical features, imaging findings, bacteriologic profile, etiology, treatment and outcome in patients presenting pyogenic liver abscess in a Tunisian hospital. METHODES: We report, in a retrospective study, 34 cases of pyogenic liver abscess that were hospitalized between January, 1st 2004 and December, 31st 2013. RESULTS: Thirty-four cases (19 males, 15 females) were found. The mean age was 64 years. The most significant clinical features of pyogenic liver abscess were upper abdominal pain with high grade fever and hepatomegaly. Thirty-one patients were investigated by CT scan, which showed a positive diagnosis in 100% of cases, 82.4% of liver abscesses were found in the right lobe of liver and were solitary in 79.4% of cases. The most causative germs, were isolated in pus culture, were Escherichia coli and Klebsiella. The most common etiologies were biliary and cryptogenic origin; portal pyemia and hematogenous origin were also found. All of patient had received intravenous antibiotic therapy (cephalosporin or fluoroquinolones combination with metronidazole and aminoglycoside) but only two patients were healed by this regime. The mean duration of intravenous antibiotic therapy was 15.5 days. The percutaneous drainage was performed in 50% (n=17) of cases and was successfully in about 70% of cases. Surgery was performed in 58.82% (n=20) of cases. Six patients had only surgical drainage of abscess and the other 14 patients had cholecystectomy with drainage of abscess.The mean length of hospital stay was 19.7 days. The outcome was generally favorable with the exception of one death from septic shock. CONCLUSION: PLA is a rare condition but has undergone a huge change. It affects the subjects increasingly older. Bacteriologically, there is an emergence of Klebsiella in favor of Escherichia coli. Its treatment became less chirurgical thanks to the development of percutaneous drainage. Its outcome is generally favorable.

PTU-104 Single Centre Management of Pyogenic Liver Abscesses: Surprisingly Poor but Mortality Still Low

IntroductionUntreated, pyogenic liver abscesses have a mortality approaching 100%. Three admissions in a week sparked interest in the best management of this condition. Although common, no comprehensive management guidelines could...

Presentation and Management of Pyogenic Liver Abscess in a 23-Week Pregnant Woman

Pyogenic liver abscess during pregnancy is an extremely rare condition. We report a case of 33-year-old, 23-week pregnant woman with pyogenic liver abscess. She was still in the hospital for medical observation of fever, when a sudden episode of tachycardia with a pulse of 210 beats per minute and tachypnea with a respiratory rate of 30 breaths per minute was encountered. At that moment, her fever was 39.6°C (103.28 Fahrenheit). The abdominal ultrasound stated a calcific echogenic mass with a measure of 6 cm in the liver region. Given the sonographic characteristics noted, a liver abscess was suspected. Our case was successfully treated with an ultrasound guided percutaneous aspiration of the abscess and a wide spectrum antibiotic. At 38 weeks of gestation, an elective cesarean delivery was performed. The female neonate weighed 3200 g with APGAR scores of 9 and 9 at the first and fifth minutes, respectively.

PTU-087 Management of pyogenic liver abscess: an 11-year retrospective study of practice at a metropolitan hospital and development of local guidelines

IntroductionPyogenic liver abscess (PLA) is an uncommon condition associated with considerable morbidity and mortality despite modern treatment. Patients have prolonged lengths of stay, require repeated imaging and procedures, and frequently...