Treatment Of Pyogenic Liver Abscess Research Articles

Clinical utility of combined contrast-enhanced ultrasound and intracavitary contrast-enhanced ultrasound in the percutaneous treatment of pyogenic liver abscess

Aim: This study aimed to evaluate the utility of the combined use of contrast-enhanced ultrasound (CEUS) and intracavitary CEUS (IC-CEUS) with diluted SonoVue in the management of percutaneous treatment for pyogenic liver abscess (PLA). Methods: 36 patients (23 males, 13 females; mean age 64 ± 13.9 years) with 39 PLAs (mean size 7.6 ± 3.4 cm) were selected for percutaneous catheter drainage (PCD) and/or percutaneous needle aspiration (PNA). CEUS and IC-CEUS were employed during the interventional maneuver and follow-up during hospital stay in all cases. Results: 33 patients with 24 PLAs underwent PCD, 8 patients with 10 PLAs were treated with single or multiple PNA, and the combination of PCD and PNA was used in the remaining 5 cases. During the treatment planning phase, the combined use of CEUS and IC-CEUS affected therapeutic choices (e.g., drainage technique, additional therapeutic measures) in comparison with pre-operative imaging in 66.7% of patients. Throughout the follow-up period, CEUS and IC-CEUS facilitated monitoring of PLA evolution, providing crucial information, especially with IC-CEUS, on the optimal timing of catheter removal. No adverse events occurred after CEUS and IC-CEUS. Conclusions: The combination of CEUS and IC-CEUS proved to be a powerful and safe tool for tailoring US-guided percutaneous treatments to patients with PLA.

The clinical significance of pyogenic liver abscess after transarterial chemoembolization or microwave ablation on malignant liver tumors: A retrospective study.

Pyogenic liver abscess (PLA) is a rare but severe complication of interventional therapy that has been little studied. We aimed to find the risk factors for PLA after transarterial chemoembolization (TACE) or microwave ablation (MWA), further explore its clinical significance and summarize our experience with its treatment. Twenty-two patients with PLA and 118 randomly selected patients without PLA after TACE/MWA were enrolled. Logistic regression was used to analyze risk factors, a nonparametric test was used to compare recovery duration, the log-rank test was used to compare progression-free survival, and Spearman correlation coefficient was calculated between the time from fever to drainage and the total duration of fever. The disease process and treatment were summarized. Sphincter of Oddi manipulation increased the risk of PLA by 70.781-fold. The PLA group took longer to recover (36.56 ± 16.42 days) than the control group (5.54 ± 4.33 days), and had a shorter progression-free survival. Escherichia coli was the major pathogenic bacterium, and multidrug resistance was found in 8 patients with E coli or Enterococcus faecium. The time from fever to drainage was 15.89 ± 13.78 days, which was positively correlated with the total duration of fever (24.29 ± 18.24 days). Overall, 18 patients recovered, and 4 patients died of PLA, for a mortality rate of 18.18%. The fever of 10 patients (45.45%) was controlled by cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium; the fever of 7 patients (31.81%) was controlled by imipenem and cilastatin sodium; and the fever of 3 patients (13.63%) was controlled by tigecycline. Sphincter of Oddi manipulation is a high-risk factor for PLA after TACE or MWA. PLA can accelerate cancer progression and even lead to death. E coli was the major pathogenic bacterium, and multidrug resistance was most common in E coli and E faecium. Timely drainage and appropriate antibiotics are the key primary measures for treating PLA. Cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium is a good choice for the first treatment of PLA, especially before pathogenic bacteria are identified. With the emergence of drug resistance, imipenem and cilastatin sodium, and tigecycline can be used for posterior treatment.

The Effect of Contrast-enhanced Ultrasound via Vessels and Surgical Drains Guidance Percutaneous Catheter Drainage in the Treatment of Pyogenic Liver Abscess.

Pyogenic liver abscess (PLA) is a purulent disease caused by microbial contamination of liver parenchyma and includes amoebic liver abscess, fungal liver abscess, and the most common bacterial liver abscess. Explore the efficacy of contrast-enhanced ultrasound (CEUS) via vessels and surgical drain guidance percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses (PLA). A total of 86 PLA patients who underwent PCD treatment in our hospital from May 2018 to February 2023 were retrospectively selected. Of them, 41 patients were treated under intravenous CEUS guidance (Control group), and 45 patients were treated under CEUS via vessels and surgical drain guidance (study group). Perioperative characteristics, treatment effectiveness, and incidence of complications were analyzed and compared between groups. The duration of surgery, drainage, white blood cell recovery, body temperature recovery, and hospitalization in the study group were longer than those in the control group (P<0.05). The total effective rate of the study group (95.56%) was higher than that of the control group (80.49%) (P<0.05). The incidence of complications in the study group (4.44%) was lower than that in the control group (19.51%) (P<0.05). Compared with intravenous CEUS alone, treatment under CEUS via vessels and surgical drains-guided PCD was associated with shorter surgical time, faster recovery, better treatment effect, lower risk of complications, and ensured treatment safety in PLA patients.

Efficacy of Tounongsan decoction on pyogenic liver abscess: network pharmacology and clinical trial validation.

To elucidate the molecular mechanisms governing the effect of Tounongsan decoction (, TNS) on the pyogenic liver abscess. Based on oral bioavailability and drug-likeness, the main active components of TNS were screened using the Traditional Chinese Medicine Systems Pharmacology platform. The GeneCard and UniProt databases were used to establish a database of pyogenic liver abscess targets. The interactive network map of drug-ingredients-target-disease was constructed using Cytoscape software (Version 3.7.2). A protein-protein interaction network was constructed using the STRING database, and the related protein interaction relationships were analyzed. biological process of gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed for the core targets. Finally, a clinical trial was performed to verify the reliability of the network pharmacology. Forty active components of TNS decoction were obtained, and 61 potential targets and 11 proteins were identified. Pathways involved in the treatment of pyogenic liver abscess include the phosphatidylinositide 3-kinases-protein kinase B (PI3K-AKT), advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE), and tumor necrosis factor (TNF) signaling pathways. The results of network pharmacology analysis combined with clinical trials validated that TNS decoction could alleviate the inflammatory response of pyogenic liver abscesses by decreasing interleukin 6 (IL-6) levels. TNS decoction has the characteristics of being multi-system, multi-component, and multi-target. Active ingredients in TNS, such as quercetin, kaempferol, fisetin, and β-sitosterol, have strong potential to be candidate drugs for treating pyogenic liver abscesses. The possible mechanism of TSN decoction includes regulating immune and inflammatory responses and reducing IL-6 production to control inflammatory development.

The New Changes of Epidemiology, Etiology, and Clinical Characteristics of Pyogenic Liver Abscesses: A Retrospective Study in a Hospital in Northern China.

To investigate the epidemiology, etiology, and clinical characteristics of patients with pyogenic liver abscesses (PLA) and provide guidance for clinical treatments. A retrospective study was performed on a cohort of 402 hospitalized patients diagnosed with PLAs at the Affiliated Hospital of Chengde Medical College between January 2016 and December 2021. Patient demographics, drug sensitivity profiles, and microbiological culture results of drainage and blood samples were thoroughly analyzed to identify significant patterns or trends. Furthermore, clinical characteristics and treatments for patients with PLA were comprehensively assessed. Patients aged 50-69 years had the highest incidence of PLA, accounting for 59.9% of all cases, and 91.5% of them had a fever. Bacterial culture analysis of the 200 patients revealed that Klebsiella pneumoniae (K. pneumoniae) was the most predominant pathogen, detected in 70.5% of cases, exhibiting an upward trend. Escherichia coli (E. coli) was the second most frequently detected pathogen, identified in 14.5% of cases, showing a downward trend. Coexisting diabetes mellitus (DM) was found to be the most common comorbidity for PLA, occurring in most patients with the condition. Patients with a history of abdominal surgery and malignancy had an increased risk for PLA, while those with gallstones had a decreased risk. Drainage combined with antibiotic therapy was identified as the primary treatment of PLA. In addition, multivariate analysis demonstrated that coexisting DM and the presence of gas in the abscess cavity were independent risk factors for septic shock in patients with PLA. This study reveals a shift in the proportions of pathogens and risk factors in patients with PLA, underscoring the necessity for improved diagnostic and therapeutic strategies.

Clinical Characteristics of 606 Patients with Community-Acquired Pyogenic Liver Abscess: A Six-Year Research in Yantai.

This study was designed to analyze the clinical characteristics, etiological characteristics, drug resistance, and empirical use of antibiotics for community-acquired pyogenic liver abscess (PLA) to provide a basis for rational and effective empirical treatment of PLA in the local area. The clinical data, etiological characteristics, drug resistance, and empirical anti-infective therapy schemes of 606 patients with PLA were collected and analyzed retrospectively. The included patients were mainly males, with a male-to-female ratio of 1.3:1. The average age of the patients was 60.3 ± 14.1 years. The underlying diseases were diabetes and biliary tract disease, accounting for 38.7% and 22.3%, respectively. The main clinical manifestations were fever (92.9%), abdominal pain (44.7%), and nausea (33.3%). Imaging findings: the proportion of patients with a single lesion was 74.7%, and 67% of the patients had involvement in the right lobe of the liver. The main pathogen was Klebsiella pneumoniae accounted for 74.9% in blood culture and 84.1% in pus culture, mainly extended-spectrum β-lactamase. In 272 strains negative for extended-spectrum β-lactamase (ESBLs), 100% were resistant to ampicillin and less than 50% were sensitive to nitrofurantoin. Only 36 ESBL-positive strains had higher than 80% sensitivity to carbapenems, β-lactamase inhibitor compound, and amikacin. Patients treated with different treatment methods showed significantly different average length of hospital stay (14 [9-21] vs 13 [8-18]). Empirical anti-infective therapy: Beta-lactamase complex, carbapenems, cephalosporins, and quinolones were used in 280 (37.6%), 180 (29.7%), 180 (29.7%), and 147 (24.3%) patients, respectively. Patients with community-acquired PLA in this area are mainly males, and the underlying diseases are mainly diabetes and hepatobiliary system disease. The main clinical manifestation is fever, so patients with fever of unknown cause should pay attention to possible liver abscesses. Based on drug sensitivity tests, the empirical use of antibiotics is somewhat unreasonable.

Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study.

Percutaneous catheter drainage is the first-line treatment for pyogenic liver abscess (PLA). Some patients need hepatectomy because of underling hepatobiliary pathology or unresponsiveness to nonoperative treatment, the traditional method is open hepatectomy (OH). Laparoscopic hepatectomy (LH) for PLA is rarely reported. The purpose of this study is to describe our experience of LH for treating PLA and to compare LH with OH. The medical records of patients who underwent LH for treating PLA were retrospectively analyzed, and the results were compared with those of patients with OH. From January 2015 to December 2021, 61 patients with PLA underwent hepatectomy, and 28 patients who underwent LH (LH group) were compared with 33 patients who underwent OH (OH group). There were no significant differences in the basic data between the 2 groups. Two patients in the LH group were converted to open surgery due to hemorrhage and dense perihepatic adhesions, there was no significant difference between the 2 groups in the operation time (186.2 ± 85.6 vs. 175.9 ± 76.7 minutes, P = .239), Institut Mutualiste Montsouris classification, extent of hepatectomy and drainage tube removal time, however, the blood loss (200.0 ± 100.5 vs. 470.9 ± 120.1 mL, P = .003), numerical rating scale (5.2 ± 1.8 vs. 9.1 ± 1.6, P = .042), the time to resume oral diet (12.3 ± 6.5 vs. 24.6 ± 10.2 hours, P = .005), the ambulant time (20.2 ± 7.3 vs. 40.2 ± 10.8 hours, P = .010), incidence of postoperative complications (14.3% vs.33.3%, P = .002), comprehensive complication index (46.2 vs. 60.6, P = .013), postoperative hospital stay (8.5 ± 7.3 vs. 13.5 ± 10.2 days, P = .025) in the LH group was significantly less than that in the OH group. Wit experience laparoscopic surgeons, treating PLA by LH is safe and feasible and compares favorably with OH.

Pyogenic Liver Abscess Caused by Acute Appendicitis: A Case Report

Pyogenic hepatic abscesses represent a pathology whose prevalence has increased in recent years. In the past, surgical treatment of pyogenic liver abscesses was the gold standard. Nowadays, percutaneous drainage has become the first-line treatment. We report the case of a pyogenic liver abscess caused by acute appendicitis. Our management consisted of a combined treatment: percutaneous drainage of the abscess followed by appendectomy.

Early percutaneous catheter drainage in protecting against prolonged fever among patients with pyogenic liver abscess: a retrospective cohort study

Background Percutaneous catheter drainage (PCD) has been viewed as first-line treatment for pyogenic liver abscess (PLA), yet detailed guidance is lacking for best practice of PCD. This study investigated characteristics of patients with PLA who had received PCD, identified factors associated with prolonged fever, and aimed to evaluate the relationship between timing of PCD and clinical improvement. Methods This was a retrospective study of patients with PLA who had undergone PCD over a 7-year period. PCD performed when the liquefaction degree of abscesses was less than 30% and/or within 1 week after fever onset was defined as early PCD. Patients were grouped and analysed based on the timing of PCD (early vs. delayed). Factors associated with prolonged fever were also analysed using univariate and multivariate logistic regression. Results Among 231 patients with PLA, 81 treated with PCD were included in the study after exclusion. The size of abscesses ranged from 3.4 to 16 cm in diameter. Interestingly, the abscesses were predominantly multiloculated in this cohort (82.7%). The most common pathogen isolated from pus was Klebsiella pneumoniae (60.5%), followed by Escherichia coli (8.6%). The duration of fever was significantly shortened with early PCD as compared to delayed PCD intervention (p = .042). No statistical differences were found between the two groups with regard to catheter adjustment and salvage drainage. Maximum body temperature and diameter of abscess > 7.5 cm were found to be associated with prolonged fever while early PCD was inversely related to prolonged fever. Multivariate analysis suggested that early PCD treatment was an independent protective factor of prolonged fever (p = .030). Conclusions Large abscesses with loculation could be successfully treated with PCD, and early PCD protected patients with PLA from prolonged fever. Our findings suggest that early intervention should be provided if PCD is indicated in clinical practice. KEY MESSAGES Large abscesses and multiloculated abscesses can be treated with percutaneous catheter drainage. Early percutaneous catheter drainage is identified as a protective factor of prolonged fever among patients with pyogenic liver abscesses. Early intervention should be provided if percutaneous catheter drainage is indicated for pyogenic liver abscesses.

Liver Abscess Formation After Laparoscopic Radiofrequency Ablation of Metastatic Colon Cancer

Radiofrequency ablation (RFA) may be used to treat either benign or malignant tumors of the liver. Complications are relatively rare, with the most common being pyogenic liver abscess formation. Risk factors for pyogenic liver abscess formation include Child-Pugh class B or C cirrhosis, biliary tract disease, diabetes mellitus, and preexisting biliary diversion. Differentiating sterile post-ablative necrosis from abscess formation may be difficult on imaging as air may be considered a normal post-ablation finding. Treatment of pyogenic liver abscesses includes drainage and antibiotics targeting the most common organisms. This case presents a 71-year-old female with none of the above risk factors who developed a pyogenic liver abscess after undergoing RFA for a solitary liver metastasis secondary to biopsy-proven colonic adenocarcinoma. She was successfully treated with antibiotics and an indwelling percutaneous drain.

CLINICAL PROFILE, DIAGNOSIS AND THERAPEUTIC MANAGEMENT OF PYOGENIC LIVER ABSCESS

Introduction:Liver abscess comprises 48% of all the visceral abscesses.Liver abscess is broadly divided into amoebic and pyogenic liver abscess with majority of the amoebic etiology in developing countries and pyogenic in developed countries. Early detection and localization secondary to advancements in CT and ultrasonography (US) advanced the treatment of pyogenic liver abscess considerably. Nowadays percutaneous treatment of pyogenic liver abscess whether single or multiple abscesses has become the standard of care. In addition, endoscopic and laparoscopic option for drainage in patients who are not responsive to antibiotic treatment have been explored with good outomes. Results: In our study, mean age of patients was 46.37 +- 17.93, Our youngest patient was 19 years of age and elder most was 80 years of age. 53.33% (24) patients were males and 46.67% (21) were females. 37 (82.22%) had high-grade fever. Majority i.e., 15/45 patients (33.33%) showed growth of Escherichia coli after 48 hours of inoculation. Streptococcus was other major group, growth was present in 24.44% of patients, in ten out of 45 patients (i.e., 22.22%), no growth was seen after 48 hours of inoculation. Klebsiellas and staph aureus was seen in five (11.11%) and four (8.89%) patients respectively. Majority 23/45 of our patients were managed by pigtail drainage i.e., 51.11%. 17/45 patients were managed by IV followed by oral antibiotics making this category of patients 37.77% of our total sample population. Open surgical drainage was done in four patients (8.88%), two out of them were directly taken for surgical intervention and other two after failure of pigtail drainage. Only one patient had to undergo Usg guided pigtail drainage after failure of IV antibiotic therapy. Conlusions: Hepatic abscesses are a relatively rare occurrence, but an important health problem nonetheless. Slight male preponderance as compared to female population. Percutaneous catheter drainage is safe and effective treatment option than minimal invasive/open surgical procedure, and is the most reliable and effective means of management.

Anaerobe coverage is important for the prognosis of pyogenic liver abscess: A population-based study in Korea

BackgroundGram-negative bacteria such as Klebsiella pneumoniae and Escherichia coli are the most common cause of pyogenic liver abscess (PLA).We investigated whether the use of anaerobic-covering antibiotics is essential for the treatment of pyogenic liver abscess. MethodsWe analyzed the Health Insurance Review and Assessment Service data in Korea between 2007 and 2017. We classified PLA into two groups: a group using antibiotics that inhibited only aerobic strains (anaerobe (-) group) and a group using antibiotics that inhibited both aerobic and anaerobic strains (anaerobe (+) group). The primary outcome was the difference in in-hospital mortality between the two groups. ResultsDuring this period, a total of 30,690 PLA patients were obtained. There were 6733 patients in the anaerobe (-) group and 23,957 patients in the anaerobe (+) group. In-hospital mortality was significantly lower in the anaerobe (+) group than the anaerobe (-) group (7.9% vs. 15.6%, p < 0.001). In multivariate analysis, the use of anaerobic antibiotics reduced the in-hospital mortality by 42% (odds ratio 0.42, 95% confidence interval 0.38–0.46, p < 0.001) after adjusting for age and comorbidities. Furthermore, the improvement of in-hospital mortality was present regardless of the presence of cancer or diabetes. ConclusionThe use of broad-spectrum empirical antibiotics covering anaerobic strains is important for the treatment of pyogenic liver abscess.

Hepato-Cutaneous Fistula: A rare delayed complication after healed Pyogenic Liver Abscess

Hepato-cutaneous fistula is a rare clinical entity which develops commonly after a complication due to hydatid disease of the liver. Few cases of it have also been reported following percutaneous catheter drainage of liver abscess due to actinomyces,burkholderia pseudomallei and entamoeba histolytica. In case of hydatid cyst of liver, it develops following spontaneous rupture or some intervention. In rest other, it always follows the percutaneous catheter drainage as a part of active underlying diseases process. Here, we report a case of Hepato-cutaneous fistula which develops four weeks after successful treatment of pyogenic liver abscess with complete resolution of abscess cavity.

English

BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood &amp; Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children

S2843 Pyogenic Liver Abscess Presenting as Obstructive Jaundice From Klebsiella Pneumoniae in Texas

Introduction: A pyogenic liver abscess (PLA) is a suppurative infection involving the hepatic parenchyma and account for roughly 80% of all liver abscesses. Traditionally, PLA was associated with intra-abdominal infections or leakage of intrabdominal bowel contents and was polymicrobial. One organism of interest is Klebsiella pneumoniae, which is the leading cause of PLA in several parts of Asia, making up 50-85% of cases. PLA with K. pneumoniae is becoming more common globally, especially here in the Unites States. PLA from K. pneumoniae often occurs in the absence of intraabdominal or hepatobiliary disease and has been associated with diabetes mellitus and underlying colorectal cancer. Early recognition and treatment of PLA is crucial to prevent development of bacteremia. PLA at presentation often includes fever (seen in 90% of cases), abdominal pain (50-75%), and elevated alk phos (60-90%), while jaundice and compression of the biliary tree (12-27%) is rarer. Case Description/Methods: A 59-year old man visiting from the Philippines with a medical history of HTN and type 2 DM presenting with five days of worsening fatigue, nausea, non-bloody vomiting, and scleral icterus was found to be in septic shock. He had developed the symptoms while in Mexico. Physical exam was notable for jaundice and hepatomegaly with a moderately distended abdomen. Presenting labs showed an elevated lactate, hyperbilirubinemia (total bilirubin 11.4, conjugated bilirubin 7.1), and increased alk phos. CT abdomen/pelvis showed a large, 12.9 cm hypo-attenuating cystic liver mass with ill-defined septations and peripheral enhancement. Blood cultures grew Klebsiella pneumonia. Patient underwent two percutaneous drain placement procedures, both of which incompletely drained the fluid. Roughly two weeks after presentation, while still in the hospital, he underwent exploratory laparotomy and successful drainage of hepatic abscess. He was monitored a few days afterwards with down trending labs before being discharged home. Discussion: Here we presented a case of septic shock and obstructive jaundice secondary to a pyogenic liver abscess with Klebsiella pneumoniae. The patient had multiple risk factors for this disease such as diabetes and being from Southeast Asia. The treatment was complicated by multiple percutaneous and surgical interventions before being stable for discharge. Being aware of K. pneumoniae causing PLA should be included on a differential for obstructive jaundice is necessary.

Liver Abscess: Complications and Treatment.

Liver Abscess: Complications and Treatment.

Bleeding risk of image-guided percutaneous catheter drainage of pyogenic liver abscess in patients with coagulopathy.

Percutaneous catheter drainage (PCD) is the mainstream treatment for pyogenic liver abscess (PLA). However, in some patients with severe coagulopathy, there may increase the risk of bleeding complications related to PCD. Therefore, this study was aimed to evaluate the incidence of bleeding complications of PCD in PLA patients complicated with coagulopathy. Between January 2011 and September 2019, patients diagnosed with PLA who had undergone PCD were selected retrospectively. Based on the preoperative coagulation parameters, the patients were divided into the coagulopathy group (PLT ≤ 50 × 109/L or INR ≥ 1.5) and the normal coagulation group. The major and minor bleeding complications related to PCD were compared between the two groups. The ICU occupancy and mortality rates in the coagulopathy group were assessed and compared with patients of normal coagulation group. A total of 583 PLA patients subjected to PCD were selected. 522 patients were finally included in this study: 64 cases (12.26%) in the coagulopathy group and 458 cases (87.74%) in the normal coagulation group. No major bleeding complications related to PCD was observed. Two patients (0.38%) of minor bleeding complications, one patient in each group, showed no statistically significant difference (0.2% vs.1.6%, P > 0.05). The ICU occupancy rate of coagulopathy group was significantly higher than normal coagulation group (6.2% vs. 0.7%, P < 0.05). No significant difference in mortality rate was noted between the two groups (4.7% vs.1.5%, P > 0.05). The incidence of bleeding complications related to PCD in PLA patients is rare even if complicated with coagulopathy.

A retrospective analysis of pyogenic liver abscess and antibiotic resistivity of common pathogens in Peshawar

Background: Pyogenic liver abscess (PLA) is a rare but life-threatening disease, with a frequency ranging from 10.83 to 17.45 per 100,000 persons. The major cause of PLA is bacterial infection of liver parenchyma. The present research study was designed to investigate the common microbes causing PLA in Peshawar (Pakistan) and to evaluate a variety of the most capable and efficient antibiotics for treatment of PLA.&#x0D; Methods: A 7-year (2012 - 2018) retrospective demographic study of medical records of all PLA patients (n = 379) admitted to the Hayatabad Medical Complex (HMC) and Khyber Teaching Hospital (KTH) was initially performed. The demographic study was followed by biochemical tests and antibiotic resistivity tests of microorganisms, isolated from available samples and selected from literature using web services.&#x0D; Results &amp; Conclusion: The demographic data revealed that 70% of the PLA patients were under the age of 50, with male predominance (male to female ratio of 3:1). It was concluded that K. pneumonia, poly-microbes (K. pneumonia and Citrobacter), and E. coli are the most common microbes involved in causing PLA in the population of Peshawar. E.coli, Citrobacter and K. pneumonia were sensitive to Cefixime and Ciprofloxacin (100% sensitivity rate), but showed significant resistance against Amoxycillin, Oxacillin and Fusidic Acid. It is, therefore, prudent to practice susceptibility-directed antibiotic therapy.

Percutaneous fine-needle aspiration for pyogenic liver abscess (3-6\u2009cm): a two-center retrospective study

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.

An Unusual Case of Pyogenic Liver Abscess Caused by Community-acquired Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt;

Hepatic abscesses are the most common type of visceral abscesses. The annual incidence is estimated at 2.3 cases per 100,000 people and is more common in men than women. A considerable proportion of pyogenic liver abscesses are caused by hepatobiliary pathologies. However, it may also result from hematogenous seeding from the systemic circulation. Most pyogenic liver abscesses are polymicrobial in nature consisting of anaerobic and enteric gram-negative bacilli species. Less than 10% of cases are caused by Staphylococcus aureus. Of these, few are caused by Methicillin-resistant Staphylococcus aureus (MRSA) and even fewer from the community-acquired strain. The clinical manifestations of pyogenic liver abscesses usually include fever, abdominal pain and non-specific symptoms like nausea, vomiting, malaise, anorexia and weight loss. Treatment of pyogenic liver abscesses consists of source control with drainage and antibiotic therapy tailored to the isolated causative organism. We present a case of a 51-year-old Caucasian man who presented with severe right upper quadrant abdominal pain of 5 days in duration. Abdominal Computed Tomography (CT) showed a 7.7 by 6.0 centimeter multi-loculated mass in the right hepatic lobe with other scattered foci throughout the liver. The abscess was aspirated with a pigtail drain placed under CT guidance. The aspirated culture grew MRSA sensitive to Doxycycline and Trimethoprim/Sulfamethoxazole.