Risk Factor For Liver Abscess Research Articles

Challenges in Management and Liver Abscess in General Hospitals with Limited Facilities: A Case Report

Introduction: Liver abscess is a mass containing pus in the liver which can develop into an intra-abdominal infection. Poor environment and sanitation, as well as difficulty in accessing clean water, are risk factors for liver abscesses. We report the findings of patients with liver abscesses, identification, and treatment from Waikabubak General Hospital. Case Presentation: Male, 34 years old, came to hospital with symptoms such as right upper abdominal pain since 1 week ago, accompanied by fever and nausea, vomiting. Two weeks previously the patient was said to have loose stools with a frequency of 3-4x/day. The patient is a farmer, drinks boiled tap water every day, and lives in a place with poor sanitation. Physical examination showed icteric sclera, liver palpable 3 fingers below the costal arch, and tenderness (+). Laboratories showed leukocytosis with a predominance of neutrophils and elevated liver enzymes. Ultrasound results showed a mass in the right lobe measuring +/- 4.2 x 4.16cm. The patient was treated with cefotaxime and metronidazole, as well as symptomatic management. Over a week showed clinical improvement, as well as a decrease in the size of the abscess. Discussion: The diagnosis is made from anamnesis, physical examination, and limited support. Determining the cause of an abscess is a challenge, the results of leukocytosis with a predominance of neutrophils are a reference in management. Environment and lifestyle are risk factors for liver abscess. Conclusion: Immediate and appropriate treatment can reduce the rate of complications. Government participation is needed to improve the quality of health and improve the quality of life of the people of West Sumba.

Safety evaluation of combination treatment of drug-eluting bead transarterial chemoembolization and immune checkpoint inhibitors for hepatocellular carcinoma: An increased risk of liver abscess with treatment interval less than one month

PurposeTo analyze the safety of combination treatment comprising drug-eluting bead transarterial chemoembolization (DEB-TACE) and immune checkpoint inhibitors (ICIs) in hepatocellular carcinoma (HCC). MethodIn total, 208 HCC patients receiving DEB-TACE were enrolled for this retrospective single-institution study. Among them, 50 patients who received ICIs at an interval less than one month from DEB-TACE were categorized into the DEB-ICI group; the remaining 158 patients were categorized into the DEB group. Albumin-bilirubin (ALBI) score before and at three months after DEB-TACE were recorded to evaluate liver function changes. Adverse events within three months after DEB-TACE were considered TACE-related and were compared between the two groups. ResultsThe DEB-ICI group had significantly higher incidence of liver abscess than the DEB group (14.0 % versus 5.1 %, p-value = 0.0337). No significant difference in the other TACE-related adverse events and change of ALBI score between the groups. Univariate logistic regression confirmed that combination with ICIs was an independent risk factor for liver abscess after DEB-TACE (odds ratio = 3.0523, 95 % confidence interval: 1.0474–8.8947, p-value = 0.0409); other parameters including subjective angiographic chemoembolization endpoint scale and combined targeted therapy were nonsignificant risk factors in this study population. In the DEB-ICI group, patients who received ICIs before DEB-TACE exhibited a trend toward liver abscess formation compared with those who received DEB-TACE before ICIs (23.8 % versus 6.9 %, p-value = 0.0922). ConclusionsCombination treatment involving DEB-TACE and ICIs at an interval less than one month increased the risk of liver abscess after DEB-TACE. Greater caution is therefore warranted for HCC patients who receive ICIs and DEB-TACE with this short interval.

Gigantic Liver Abscess in Pregnancy : A Rare Case

Liver abscess (LA) is defined as a suppurated cavity caused by invasion and multiplication of microorganisms within liver parenchyma. Incidence of LA is rare with 20/100,000 admissions. Etiology of LA can be bacterial, parasitic, mixed or more rarely fungal. Amoebic liver abscess (ALA) is one of the most sequelae invasive amoebiasis with 44.1% LA in patients were caused by ALA.. Early treatment initiation is important to avoid the potential risks of preterm delivery, fetal infection, perinatal mortality, multi-organ dysfunction, sepsis, septic shock, and even maternal death. Methods tis research was case report : A 27 year old patient diagnosed with G1P0A0L0 16-17 weeks of pregnancy with LA, previously the patient went to Emergency room with complaint of upper right abdominal pain since a week and getting worsed since 1 day. The patient also complaint fever and swelling at the right abdomen. From physical examination found swelling and tenderness in the right abdomen, palpable flat surface mass and dim percussion. From an ultrasound examination is a single intrauterine live fetus, gravid 16-17 weeks according to biometry, a hypoechoic mass appeared measure 11.6 x 9.6 cm, suspected liver abscess. Then she underwent laparoscopy abscess drainage with digestive surgery collaboration, from hystopathology the result was chronic inflamation acute exaserbation might from liver abscess. Liver abscess (LA) during pregnancy is an extremely rare condition. Pregnancy has been described as a risk factor for LA because of immunological changes. Imaging modalities should be chosen with caution in the pregnant patient

Diabetes and obesity and risk of pyogenic liver abscess

Few literatures discussed the relationship of glycemic control and body mass index (BMI) with the risk of pyogenic liver abscess. We conducted a population-based cohort study using participants of a community-based health screening program in Taiwan from 2005 to 2008 (n = 125,865). Information on fasting plasma glucose (FPG), BMI, and other potential risk factors of liver abscess were collected at baseline. Incidence of pyogenic liver abscess was ascertained using inpatient records from the National Health Insurance database. During a median 8.6 years of followed up, 192 incident cases of pyogenic liver abscess were reported. The incidence rate of pyogenic liver abscess was 70.2 and 14.7 per 100,000 in the diabetic and non-diabetic population respectively. In multivariable Cox regression analysis, the adjusted hazard ratio (HR) was 2.18 (95% confidence interval (CI) 1.22–3.90) in patients with diabetes with good glycemic control (FPG ≤ 130 mg/dl) and 3.34 (95% CI 2.37–4.72) in those with poor glycemic control (FPG > 130 mg/dl), when compared with non-diabetics. In the dose–response analysis, the risk of liver abscess increased monotonically with increasing FPG. After adjusting for diabetes and other comorbidities, overweight (25 ≤ BMI < 30) (adjusted HR: 1.43, 95% CI 1.05–1.95) and obese (BMI ≥ 30) (adjusted HR: 1.75, 95% CI 1.09–2.81) populations had a higher risk of liver abscess when compared to people with normal weight. Diabetes, especially poorly controlled disease, and high BMI were associated with higher risk of pyogenic liver abscess. Improving glycemic control and weight reduction may reduce the risk of developing pyogenic liver abscess.

Fusobacterium Nucleatum : An Atypical Cause of Pyogenic Liver Abscess in an Apparently Immunocompetent Patient

Pyogenic liver abscess is an uncommon but potentially lethal infection if left untreated. Enteric bacteria and anaerobes are the most common causative organisms of pyogenic liver abscess. Although most infections are of a polymicrobial nature, monomicrobial infections are possible. An immunocompromised status and the presence of periodontal disease are the risk factors for liver abscess caused by these rare, monomicrobial anaerobic infections. Here, we report on a successful non-operative management of a case of multiloculated pyogenic liver abscess caused by Fusobacterium nucleatum in a young, healthy, immunocompetent male patient. The diagnosis was established by radiological imaging and was based on a positive aspirate culture, whereas the mainstay of treatment comprised percutaneous drainage and a prolonged course of antibiotics. Thus, the patient was successfully treated with a 2-week course of intravenous imipenem/cilastatin while he was on percutaneous drainage, and he is now doing well.

The incidence of liver abscesses after TAE for patients with postpancreatectomy hemorrhages

Introduction: Pancreatobiliary surgery has been associated with high rates of mortality and morbidity. Recently, advances in interventional radiology (IVR) have reduced the postoperative mortality rates of complications such as pseudoaneurysms or postpancreatectomy hemorrhages related to pancreatic fistulas. However, transcatheter arterial embolization (TAE) sometimes results in liver abscess (LA). Therefore, this study aimed to assess the frequency and risk factors for LA after TAE for hepatic arteries. Method: We retrospectively reviewed the records of patients who underwent a pancreatoduodenectomy (PD) or bile duct resection (BDR) from January 2008 to December 2017. Preoperative, intraoperative, postoperative, and post-IVR factors were analyzed. Result: 339 patients underwent PD or BDR for pancreatobiliary disease, and 24 (7.1%) patients were performed TAE for the hepatic artery with postoperative hemorrhages (PPH) or pseudoaneurysms (PA). The median postoperative interval of performing TAE was 16 days (2-42). LA was observed in 7 cases (29.1%). The median interval in which LA occurred after TAE was 25 days (4-89). Multivariate analyses showed that diabetes mellitus (p<0.0001), bile leakage (p=0.002), pre-IVR max G-GTP>150 (p=0.003), pre-IVR max PT-INR>1.28 (p=0.006), and post-IVR max PT-INR>1.56 (p=0.019) were correlated with LA. Conclusion: The risk factors of LA after TAE for the hepatic artery are diabetes mellitus and bile leakage. High levels of pre-IVR G-GTP, PT-INR, and post-IVR PT-INR may be factors predicting the onset of LA after TAE for the hepatic artery.

Incidence and Risk Factors for Liver Abscess After Thermal Ablation of Liver Neoplasm.

BackgroundRadiofrequency ablation (RFA) and microwave ablation (MWA) are the most frequently used thermal ablation methods for the treatment of liver cancer. Liver abscess is a common and severe complication of thermal ablation treatment.ObjectivesThe objective of this study was to determine the incidence and risk factors of liver abscess formation after thermal ablation of liver cancer.Materials and MethodsThe clinical data of 423 patients who underwent 691 thermal ablation procedures for liver cancer were collected in order to retrospectively analyze the basic characteristics, incidence, and risk factors associated with liver abscess formation. Patients with multiple risk factors for liver abscess formation were enrolled in a risk factor group, and patients with no risk factors were enrolled in a control group. The chi-square test and multiple logistic regression analysis were used to analyze the relationship between the occurrence of liver abscesses and potential risk factors.ResultsTwo hundred and eight patients underwent 385 RFA procedures, and 185 patients underwent 306 MWA procedures. The total incidence of liver abscesses was 1.7%, while the rates in the RFA group (1.8%) and MWA groups (1.6%) were similar (P > 0.05). The rates of liver abscesses in patients who had child-pugh class B and class C cirrhosis (P = 0.0486), biliary tract disease (P = 0.0305), diabetes mellitus (P = 0.0344), and porta hepatis tumors (P = 0.0123) were 4.0%, 6.7%, 6.5%, and 13.0%, respectively. There was a statistically significant difference between these four groups and the control group (all P < 0.05). The incidence of liver abscesses in the combined ablation and percutaneous ethanol injection (PEI) group (P = 0.0026) was significantly lower than that of the ablation group (P < 0.05).ConclusionsThe incidence of liver abscesses after liver cancer thermal ablation is low. Child-Pugh Class B and Class C cirrhosis, biliary tract disease, diabetes mellitus, and porta hepatis tumors are four significant risk factors. Combined ablation and PEI reduces the rate of liver abscesses.

A prediction model for liver abscess developing after transarterial chemoembolization in patients with hepatocellular carcinoma

Liver abscess is a rare but potentially fatal complication of transarterial chemoembolization. Other than for biliary abnormalities, risk factors for liver abscess formation after transarterial chemoembolization have rarely been discussed. To identify other risk factors of liver abscess after transarterial chemoembolization in patients with hepatocellular carcinoma. Data for 5299 patients with hepatocellular carcinoma who underwent transarterial chemoembolization from July 1999 to December 2009 were retrospectively reviewed. 72 patients who experienced liver abscess after transarterial chemoembolization were enrolled as a case group, which was compared with a randomly selected control group (n=1009) of patients who did not develop liver abscess after transarterial chemoembolization. Pneumobilia, type 2 biliary abnormality, type 1 biliary abnormality, diabetes mellitus, tumour number (≥3), tumour size (≥3cm), and tumour necrosis on the pre-transarterial chemoembolization computed tomography, and gelfoam embolization and vessel injury during transarterial chemoembolization were all significant predisposing factors for liver abscess after transarterial chemoembolization. A prediction model for postembolization liver abscess was developed from these risk factors. The group of patients with risk scores greater than 71 showed a significantly increased risk of liver abscess after transarterial chemoembolization. These high-risk patients should be monitored carefully after transarterial chemoembolization.

Epidemiology and mortality of liver abscess in end-stage renal disease dialysis patients: Taiwan national cohort study.

Background and ObjectivesTo determine the incidence rates and mortality of liver abscess in ESRD patients on dialysis.Design, Setting, Participants, & MeasurementsUsing Taiwan’s National Health Insurance Research Database, we collected data from all ESRD patients who initiated dialysis between 2000 and 2006. Patients were followed until death, end of dialysis, or December 31, 2008. Predictors of liver abscess and mortality were identified using Cox models.ResultsOf the 53,249 incident dialysis patients identified, 447 were diagnosed as having liver abscesses during the follow-up period (224/100,000 person-years). The cumulative incidence rate of liver abscess was 0.3%, 1.1%, and 1.5% at 1 year, 5 years, and 7 years, respectively. Elderly patients and patients on peritoneal dialysis had higher incidence rates. The baseline comorbidities of diabetes mellitus, polycystic kidney disease, malignancy, chronic liver disease, biliary tract disease, or alcoholism predicted development of liver abscess. Overall in-hospital mortality was 10.1%.ConclusionsThe incidence of liver abscess is high among ESRD dialysis patients. In addition to the well known risk factors of liver abscess, two other important risk factors, peritoneal dialysis and polycystic kidney disease, were found to predict liver abscess in ESRD dialysis patients.

Pyogenic Liver Abscess as the Initial Manifestation of Underlying Hepatocellular Carcinoma

Background Pyogenic liver abscess and hepatocellular carcinoma are common in Taiwan. We investigated the frequency of, risk factors for, and prognosis of pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma over a 12-year period in Taiwan. Methods We extracted 32,454 patients with pyogenic liver abscess from a nationwide health registry in Taiwan during the period 1997-2008. The frequency of and risk factors for pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma were determined. The prognosis of these patients was compared with patients with hepatocellular carcinoma but without liver abscess. Results A total of 698 (2.15%) patients presented with liver abscess as the initial manifestation of underlying hepatocellular carcinoma during the 12-year period. Liver cirrhosis, hepatitis B virus infection, hepatitis C virus infection, and age ≥65 years were independent risk factors for liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Furthermore, these patients had a lower 2-year survival rate than patients with hepatocellular carcinoma but without liver abscess (30% vs 37%; P = .004). Conclusions The prognosis of patients who presented with pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma was poor. Physicians should not ignore the possibility of underlying hepatocellular carcinoma in patients with risk factors for the disease in regions with a high prevalence of both pyogenic liver abscess and hepatocellular carcinoma.

Impaired Phagocytosis of Capsular Serotypes K1 or K2Klebsiella pneumoniaein Type 2 Diabetes Mellitus Patients with Poor Glycemic Control

Diabetes mellitus (DM) and capsular serotypes K1 and K2 Klebsiella pneumoniae have been identified as risk factors for liver abscess and complicated endophthalmitis. The objective of this study was to determine whether poor glycemic control contributes to the development of capsular serotype K1 or K2 K. pneumoniae liver abscess. Neutrophil phagocytosis in patients with type 2 DM and nondiabetic controls was compared with isolates from liver abscess. Phagocytic rates of 18 K1/K2 and nine non-K1/K2 K. pneumoniae strains were evaluated by flow cytometry and electron microscopy. PATIENTS OR STUDY PARTICIPANTS: Forty patients with type 2 diabetes, 14 with good glycemic control, 26 with poor glycemic control, and 13 age-matched healthy normal subjects, were studied. Phagocytic rate of K. pneumoniae was measured. Phagocytosis of serotype K1/K2 isolates by neutrophils from diabetics was significantly less than normal controls (P < 0.01). Further analysis revealed that, in type 2 DM patients with poor glycemic control, phagocytosis of K1/K2 was remarkably impaired at 10 min (25.2 +/- 1.7 vs. 42.4 +/- 1.8%) and persisted until 60 min (51 +/- 1.2 vs. 59.4 +/- 1.4%; P < 0.01), but in type 2 DM patients with good glycemic control were similar at 10 min (38.2 +/- 1.7% vs. 42.4 +/- 1.8%) and at 60 min (57 +/- 0.3% vs. 59.4 +/- 1.4%; P = 0.2). No significant difference in the phagocytosis of non-K1/K2 K. pneumoniae among all subjects was observed. Poor glycemic control plays a role in impairing neutrophil phagocytosis of K1/K2 K. pneumoniae, but does not significantly affect the phagocytosis of non-K1/K2 K. pneumoniae. This study identifies poor glycemic control as a risk factor for susceptibility to serotype K1/K2 K. pneumoniae liver abscess and complicated endophthalmitis.

Liver abscess formation after hepatic chemoembolization for metastatic pancreatic neuroendocrine tumor

Hepatic chemoembolization is an effective treatment of unresectable hypervascular hepatic tumors, but history of bilioenteric anastomosis is a major risk factor for liver abscess due to the retrograde enteric bacterial contamination. We report a case of culture‐negative liver abscess developed after hepatic chemoembolization for a metastatic pancreatic endocrine tumor, and discuss the pathogenesis of liver abscess formation. We also present a potential pitfall for the prophylactic antibiotic therapy in a patient with a history of bilioenteric anastomosis. This is the first report of a culture‐negative liver abscess caused by hepatic chemoembolization for a metastatic pancreatic endocrine tumor.

Risk Factors for Liver Abscess Formation after Hepatic Chemoembolization

To assess the frequency and risk factors for liver abscess after hepatic chemoembolization. The authors performed retrospective analysis of 397 chemoembolization procedures in 157 patients. All patients received prophylactic intravenous antibiotics before the procedure and 5 days of oral antibiotics after the procedure. The association between abscess formation and risk factors was determined with use of chi(2) analysis and the Fisher exact test and expressed as an odds ratio. Liver abscess occurred in seven of 157 patients (4.5%) after eight of 397 procedures (2.0%) at a mean of 19 d +/- 7 after chemoembolization. No patients had neutropenia. Organisms isolated reflected intestinal flora. Six patients required percutaneous drainage for 35 d +/- 29. The seventh patient required drainage for the remainder of life as a result of a nonhealing biliary fistula. Three of 24 patients with neuroendocrine tumors had abscesses (12.5%; odds ratio, 4.6; 95% CI, 0.96-22.1; P =.07), as did three of 14 patients with gastrointestinal sarcomas (21%; odds ratio, 9.5; 95% CI, 1.9-47.8; P =.016), and one of two with pancreatic adenocarcinoma. Six of the seven patients with abscesses underwent a Whipple procedure before chemoembolization. Only one patient with a history of a Whipple procedure did not develop an hepatic abscess. In the absence of a bilioenteric anastomosis, abscess occurred in only one of 150 patients (0.7%), or one of 383 procedures (0.3%). The odds ratio for liver abscess among patients with a bilioenteric anastomosis was 894 (95% CI, 50-16,000; P <.0001). Earlier bilioenteric anastomosis is the major determinant of liver abscess formation after hepatic chemoembolization. The prophylaxis regimen used failed to prevent abscess formation in patients with earlier bilioenteric anastomosis.

Bacterial infections associated with hepatic arteriography and transarterial embolization for hepatocellular carcinoma: a prospective study.

Sepsis and liver abscess are serious complications following transarterial embolization (TAE) for hepatocellular carcinoma (HCC). However, the exact incidence and the necessity of antibiotic prophylaxis remain undetermined. Between November 1996 and November 1997, we prospectively studied bacterial infections in 231 HCC patients who underwent 287 angiographic procedures without antibiotic prophylaxis, including 176 TAEs and 111 hepatic arteriographies (HAs). Four of the 111 HAs were complicated by transient asymptomatic bacteremia. Of the 176 TAEs, 2 were associated with asymptomatic bacteremia, and 7 (4%) were associated with symptomatic bacterial infection, including 3 cases of sepsis, 2 of liver abscess, and 2 of infected biloma. For patients with HCC, TAE was associated with a higher risk of developing symptomatic bacterial infections than was HA (4% vs. 0, respectively; P = .03). Previous gastrectomy was the only possible risk factor for liver abscess. Finally, early diagnosis and treatment of these infectious complications usually result in successful outcome.

Clinical Differentiation of Abscess From Neoplasm in Newly Diagnosed Space- Occupying Lesions of the Liver

The clinical presentations of liver abscess, hepatoma, and metastatic tumor to the liver may be quite similar, and procedures such as computerized tomography, radionuclide scanning, and ultrasonography of the liver cannot make a specific diagnosis. Therefore, we compared the clinical presentations of 38 patients seen during the last five years with liver abscess (13 patients), hepatoma (eight patients), and undifferentiated carcinoma metastatic to the liver (17 patients). Patients with liver abscess were distinguished from the other two groups by a significantly shorter prodrome, a history of known risk factors for liver abscess, fever, leukocytosis, and a normal-sized liver (P values all less than .1). A finding of three or more of these criteria correctly identified all cases of liver abscess. Only one of the 25 patients with neoplasms had three of the criteria. The presence of multiple or single lesions, abdominal pain, weight loss, or liver function abnormalities did not differ significantly among the three groups. Thus patients with liver abscess can be reliably differentiated from patients with hepatic neoplasms by clinical criteria alone, and appropriate empiric antibiotic therapy can be started while the diagnosis is being confirmed.