Treatment Of Pyogenic Liver Abscess Research Articles

Treatment of pyogenic liver abscess in a tertiary hospital in South Africa

Treatment of pyogenic liver abscess in a tertiary hospital in South Africa

Pyogenic liver abscess: treatment modalities

Background: Treatment of pyogenic liver abscesses (PLA) is not well codified yet. Our aim is to compare treatment modalities of PLA that are antibiotics, percutaneous drainage and surgical drainage. Methods: We performed a retrospective analysis of 36 patients with PLA admitted in the Surgery unit of Mongi Slim Hospital between january 2003 and december 2013. Patients were distributed in three groups and compared retrospectively : The first group was treated by antibiotics only. The second group was treated by antibiotics and percutaneous drainage. The third group was treated by antibiotics and surgical drainage, with or without percutaneous treatment. The three groups were matched by age, sex, comorbidities and characteristics of PLA. Patient’s outcomes, including duration of symptoms, length of hospital stay, procedure-related complications, treatment failure and death were recorded. Results: Medium age was 60 years. Sex ratio was 2,27. Ultrasound made diagnosis in 79,4% of cases. Computed tomography showed abnormalities in 97,1% of cases. Mortality rate was 16,6%. Most deaths occured in surgical drainage group. Longest duration of symptoms and hospital stay were found in the group treated by antibiotics only. Procedure-related complications and failure were not significantly different between the three groups. Conclusion: Percutaneous drainage is the best treatment for PLA. Surgical drainage must be undertaken in case of abdominal emergency. Exclusive medical management should be avoided and reserved for small PLA.

Pyogenic liver abscess: treatment modalities

Background: Treatment of pyogenic liver abscesses (PLA) is not well codified yet. Our aim is to compare treatment modalities of PLA that are antibiotics, percutaneous drainage and surgical drainage. Methods: We performed a retrospective analysis of 36 patients with PLA admitted in the Surgery unit of Mongi Slim Hospital between january 2003 and december 2013. Patients were distributed in three groups and compared retrospectively: The first group was treated by antibiotics only. The second group was treated by antibiotics and percutaneous drainage. The third group was treated by antibiotics and surgical drainage, with or without percutaneous treatment. The three groups were matched by age, sex, comorbidities and characteristics of PLA. Patient’s outcomes, including duration of symptoms, length of hospital stay, procedure-related complications, treatment failure and death were recorded. Results: Medium age was 60 years. Sex ratio was 2,27. Ultrasound made diagnosis in 79,4% of cases. Computed tomography showed abnormalities in 97,1% of cases. Mortality rate was 16,6%. Most deaths occured in surgical drainage group. Longest duration of symptoms and hospital stay were found in the group treated by antibiotics only. Procedure-related complications and failure were not significantly different between the three groups. Conclusion: Percutaneous drainage is the best treatment for PLA. Surgical drainage must be undertaken in case of abdominal emergency. Exclusive medical management should be avoided and reserved for small PLA.

Pyogenic liver abscess: a retrospective study of 208 cases in a single surgery department

Introduction: Pyogenic liver abscesses (PLA), a special suppurative infection of the hepatic parenchyma, accounted for 48 percent of visceral abscesses. Among risk factors diabetes mellitus, underlying hepatobiliary or pancreatic disease were identified. Methods: We performed a retrospective study during the period between January 2003 and January 2016. Demographic data, underlying disease, clinical presentation and treatment were analyzed. Results: 208 patients with (PLA) were identified. The mean age was 62,1±17,6 years, 125 patients were male (male to female ratio 1,5:1). The most common presenting sintomatology were fever (88%), followed by abdominal pain (70,7%), nausea (59,8%), anorexia (56,5%) and jaundice (21,7%). Underlying comorbidities like diabetes mellitus, alcoholism, or inmunocompromised (recipient of a liver transplant) were presented in 36,6%, 19,8% and 9,7% respectively. The most common abscess location was the right hepatic lobe (73,9%), followed by the left one (18,5%), being both side located in 7,6%. CT and abdominal US were used in all 208 patients. The average maximum diameter of an abscess was 5,9±3,3 cm. K. pneumoniae was identified in the 20% of the patients in the aspiration culture. Portal vein thrombosis was identified in 9,8% of the patients. Percutaneous drainage (PD) was performed in 131 patients (63%). 15 patients needed surgical intervention because of the underlying cause; in 10 of them a cholecystectomy and surgical drainage was performed, in 3 a laparoscopic drainage, and in one patient a left hepatectomy was required. Conclusions: The mainstay treatment of PLA was PD. K. pneumoniae is an emerging cause of PLA in our region.

Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies.

Pyogenic liver abscess (PLA) of biliary origin in Southeast Asia mainly occurs in patients with intrahepatic bile duct stone (IBDS) and extrahepatic bile duct stone (EBDS), bilioenteric anastomosis, or biliary stent. IBDS, as an endemic to Southeast Asia, remains a frequent etiology of acute cholangitis and PLA. PLA related to IBDS is characterized by high incidences of PLA recurrence and death related to infection, and difficulties in diagnosis of concomitant cholangicarcinoma. PLA of biliary origin is more likely caused by Escherichia coli, more often presented as polymicrobial infections, and more associated with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae isolates. In this review, the authors summarize the differences on the presumed causes, pathogens, multidrug resistance, treatment, and prognosis of PLA between biliary origin and cryptogenic origin, the latter serving as a first and foremost presumed etiology of PLA. The authors also discuss the existing problems on early diagnosis of concomitant cholangicarcinoma related to IBDS.

Eikenella corrodens endocarditis and liver abscess in a previously healthy male, a case report

BackgroundEikenella corrodens is one of the HACEK bacteria constituting part of the normal flora of the oropharynx, however, still an uncommon pathogen. We report a case of a large Eikenella corrodens liver abscess with simultaneously endocarditis in a previously healthy male.Case presentationA 49-year-old Danish man was admitted because of one-month malaise, fever, cough and unintentional weight loss. On admission there was elevated white blood cell count and C-reactive protein, as well as affected liver function tests. Initially pneumonia was suspected, but due to lack of improvement on pneumonia treatment, a PET-CT scan was performed, which showed a large multiloculated abscess in the liver. The abscess was drained using ultrasound guidance. Culture demonstrated Eikenella corrodens. Transesophageal echocardiography revealed aortic endocarditis. The patient was treated with antibiotics and abscess drainage, on which he slowly improved. He was discharged after 1.5 months of hospitalisation. On follow-up 2 months later, the patient was asymptomatic with normalized biochemistry and ultrasound showed complete regression of the abscess.ConclusionsThis is the first case of documented Eikenella corrodens concurrent liver abscess and endocarditis. The case report highlights that Eikenella corrodens should be considered as a cause of liver abscess. Empirical treatment of pyogenic liver abscess will most often cover Eikenella corrodens, but the recommended treatment is a third generation cephalosporin or a fluoroquinolon. A multiloculated liver abscess may require drainage several times during treatment. The finding of Eikenella corrodens should elicit an echocardiography to diagnose endocarditis even in patients without clinical signs of endocarditis.

Pyogenic Liver Abscess with Streptococcus mitis as Causative Agent

Pyogenic liver abscesses caused by Streptococcus viridans is a rare etiology and only two cases have been reported in the literature. We report a 40-year-old male who presented with intermittent fevers, abdominal pain, and a right hepatic lobe mass on abdominal ultrasound and abdominal computed tomography. Blood tests showed elevated liver enzymes. The patient underwent drainage of the abscess. Culture of the purulent material obtained yielded Streptococcus mitis as the causative agent. Treatment of pyogenic liver abscesses is crucial and involves invasive approaches such as drainage. In addition, bacteriological studies must be performed as well to isolate the specific agent and provide appropriate antimicrobial therapy. A 40-year-old male presented with a three week history of intermittent fevers, generalized fatigue, abdominal pain, and upper respiratory symptoms. The patient was diagnosed with strep throat one month prior to his admission to the hospital. He was given a ten-day course of Penicillin and had initial resolution of symptoms. Soon after, the fevers recurred along with chills and night sweats. He also complained of diffuse intermittent abdominal pain greatest in the right upper quadrant. The physical examination was remarkable for scleral icterus and tenderness to palpation in the right upper quadrant. Investigations showed a white cell count of 15.2 K/uL, neutrophils 85%, aspartate aminotransferase 69 IU/L, alanine transaminase 102 IU/L, alkaline phosphatase 358 IU/L, total bilirubin 1.4 mg/dL, direct bilirubin 1.0 mg/dL. CEA, CA 19-9, and AFP tumor markers were negative. Blood cultures were negative. Abdominal ultrasound revealed an irregular right hepatic lobe mass predominantly hypoechoic but contained some solid appearing internal echogenic components. The mass measured 5.4 x 5.1 x 4.9 centimeters. Abdominal computed tomography confirmed the presence of a right hepatic lobe mass occupying predominantly hepatic segment six with slight extension into hepatic segment seven. The patient then underwent percutaneous computed tomography guided abscess drainage with placement of a drainage catheter. There was approximately 50 milliliters of purulent material, bloody in nature, aspirated from the mass which was sent for culture. The abscess culture grew Streptococcus mitis sensitive to quinolones. The patient was placed on moxifloxacin therapy for a total of two weeks and had the drainage catheter removed after two weeks as drainage was minimal.Figure 1Figure 2

Current treatment of pyogenic liver abscesses: analysis of a multi-modal step-wise algorithmic approach

Current treatment of pyogenic liver abscesses: analysis of a multi-modal step-wise algorithmic approach

An Atypical Presentation of Pyogenic Liver Abscesses

Introduction: Pyogenic liver abscesses (PLA) often present with classic signs and symptoms and have a high mortality rate if not treated timely. Our patient presented with respiratory symptoms secondary to PLA following cholecystectomy 1 year ago. The patient is a 73-year-old male who presented with a 6-month history of worsening shortness of breath. He also reported a 125-pound weight loss over the past year. His symptoms began post cholecystectomy, and an abdominal computed tomography (CT) scan demonstrated multiple liver infiltrates, which were initially thought to be bilomas or bile leaks. He presented with stable vital signs, and a subsequent CT scan showed a right-sided pleural effusion with multiple abscesses in the liver, the largest being 9.1 x 4.9 cm. He was initiated on intravenous ciprofloxacin and Imipenem, as well as interventional radiology-guided drain in the largest abscess. The patient demonstrated significant clinical and radiologic improvement. PLA usually occur after portal vein pyemia, secondary to bowel leakage and peritonitis, but may also occur due to infection secondary to obstruction or penetrating wounds. PLA usually presents with right upper quadrant pain, fever, chills, and weight loss. Patients with single abscess may have an insidious course, but multiple abscesses usually present with acute symptoms. This case is unique in that our patient had an insidious presentation with uncommon clinical features, which makes early suspicion of the disease difficult. In spite of untreated multiple abscess, which carries a very high mortality, our patient was not acutely sick and did not require intensive care. A right-sided pleural effusion can be seen in some cases. These findings should prompt additional investigation such as right upper quadrant ultrasonography or CT scan. Cultures obtained from existing drains should not be used to guide antimicrobial therapy. The diagnosis of PLA is made by history, clinical examination, and radiographic imaging, along with aspiration and culture of the abscess material. Treatment of PLA should include drainage and antibiotic therapy.Figure 1

Pyogenic Liver Abscess Following Pancreaticoduodenectomy: Risk Factors, Treatment, and Long-Term Outcome

BackgroundPancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD. MethodsWe retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994–January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD. ResultsPLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2 %) or antibiotics alone (N = 7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p = 0.014) or who required reoperation (18.2 vs. 1.5 %, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls. ConclusionsPostoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.

Role of C-reactive protein in response-guided therapy of pyogenic liver abscess

Protocols for antibiotic treatment of pyogenic liver abscess (PLA) are usually based on clinicians' own experience without any validation. Our study was to evaluate the clinical implication of C-reactive protein (CRP) in predicting treatment outcome and adequacy of antibiotic therapy of PLA. Patients with PLA in whom white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and CRP were checked regularly during the clinical course were included. The prolife of CRP during the clinical course was compared with that of ESR and WBC. The usefulness of CRP in predicting the chance of recovery and adequacy of antibiotic therapy was examined. From 2000 to 2011, 109 patients with PLA underwent regular monitoring of WBC, ESR, and CRP. Except for ESR, both WBC and CRP showed an initial rapid reduction in first 3 weeks, followed by a relatively slow decrease. From week 3 to week 6, the CRP ratio (relative to CRP at week 1) of patients with and without adverse events (i.e. including mortality) was compared; a significant difference was found at week 3 (P=0.001), week 4 (P=0.004), week 5 (P=0.011), and week 6 (P=0.018), whereas no statistically significant difference was found in the WBC ratio over the same period. By week 3, a CRP ratio of 0.423 or less was a marker of good outcome (sensitivity 0.846; specificity 0.667) and was also a marker of adequacy of antibiotic therapy of 5 weeks or less (sensitivity 0.786; specificity 0.714) if the ratio was 0.278 or less. Weekly CRP measurement was useful in the identification of patients with PLA with good outcome and adequacy of antibiotic therapy of 5 weeks or less.

Pyogenic Liver Abscess: Prospective Evaluation Of USG Guided Percutaneous Therapeutic Aspiration

Background: Pyogenic liver abscess (PLA) has been a condition of high mortality, improving over recent decades with combined antibiotic and percutaneous drainage Percutaneous drainage is currently the treatment of choice in liver abscess. Percutaneous needle aspiration(PNA) as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of PLA has never been popular. AimsO 15 female; most common age range 40-50 years; mean age 44.34 years) with PLAs (mean diameter 6.52±1.8 cm; range 4.8- 9cm) underwent PNA with ultrasound (USG) guidance and antibiotic therapy. Complete pus removal from each abscess was attempted with 18 gauge thin-walled trocar needles with USG guidance. If necessary, PNA was repeated every 3 day. Results: The percentage of abscesses requiring one, two, three and more sessions of aspiration was 50%, 30%, 18% and 2% respectively. The success rate was unrelated to the largest size or number of abscess in the patient. Cure (normalization of clinical and laboratory parameters and resolution of hepatic lesions) was achieved in all patients (100%).. Patients were hospitalized for 7-22 days (mean11±4.56days) No patient needed imaging-guided percutaneous catheter drainage or open surgical. Neither complications nor deaths ensued. Recurrence of PLA was not observed in any patient during follow-up (6-12) months Conclusions: USG-guided PNA with antibiotic therapy in treatment for PLA is a safe, effective & low-cost procedure. It should be considered as a first line alternative to catheter drainage. Our data suggest that a trial of percutaneous needle aspiration should always be undertaken before catheter drainage or surgery.

Percutaneous treatment of large pyogenic liver abscess

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 either via needle aspiration or percutaneous catheter drainage (CD). There is a debate about which is better intermittent needle aspiration or CD.Our objective is to compare the outcome of CD versus intermittent needle aspiration of pyogenic liver abscess and to compare the single step Trocar technique versus the modified Seldinger technique. Patients and methods88 patients, 65 men and 23 women, mean age 44.6 (18–73) years had pyogenic liver abscess. Patients were divided in two groups randomly; aspiration group with maximum of three attempts and the CD group. Ultrasound or CT was used. ResultsAspiration was successful in 60% of cases (26/43). CD was successful in 98% (44/45). Three patients were treated by surgical drainage (two patients of the aspiration group and one of the CD group) with favorable outcome. Both Seldinger and single step Trocar techniques were comparable as regards outcome and procedure-related pain but the procedure time of Trocar was significantly shorter. No major complications were encountered. ConclusionCD is more efficient than needle aspiration. Aspiration can be used for simple small abscesses. Trocar technique is less time-consuming than the Seldinger technique.

Hepatobiliary cancer and pyogenic liver abscess: when poking the skunk is not enough: Invited Commentary on Chen, et al. Am J Surg 2013;205:52–7

Patients with hepatobiliary or pancreatic cancer who develop pyogenic liver abscesses (PLAs) are an incredibly complex group of patients. First, these patients often harbor advanced malignancies that are associated with immune suppression. Furthermore, these cancers result frequently in biliary obstruction that can lead to overt or insipid cholangitis and subsequent liver abscess formation. If the cancer or associated obstructed biliary tree is not recognized promptly, patients may develop multiple abscesses or multiloculated abscesses, which are notoriously difficult to treat. In addition, the performance status of these patients is typically poor, and therefore, complicated invasive treatment plans are tolerated poorly. Moreover, data from the past 15 years suggest that the incidence of PLA is increasing, and most of PLAs are associated with cancer.1,2 Most of these PLAs are now treated with percutaneous drainage and antibiotics.3 The report by Lai et al4 in this issue adds valuable insight into the treatment of PLAs in patients with hepatobiliary malignancies. In this series of 44 patients with PLAs, treatment with percutaneous drainage failed in 34%. Importantly, the mortality in these 15 patients was an astounding 60%. Twelve of these 15 patients underwent salvage surgery, but only 6 survived. Factors associated with failure of percutaneous drainage on multivariate analysis were multiloculated abscesses and abscesses with biliary communication. The overall mortality for all patients was 32%, which is not surprising, considering that previous work has clearly demonstrated mortality ranging from 5.6% to 33%.1-3,5 Thus, the dilemma for surgeons treating patients with cancer with PLAs is to recognize early those patients with high likelihood of failure of percutaneous drainage. Aside from those factors identified by multivariate analysis, the data presented offer some clues. Patients in whom percutaneous drainage failed were older (P =.061), had multiple abscesses (P = .042), and took longer to defervesce after admission (P = .052). Most patients who responded to treatment were without fever within 5 days of treatment. Therefore, a persistent fever should be an indicator that percutaneous management may not be the remedy. Likewise, an obstructed biliary tree may be a persistent nidus of infection, and thus, biliary decompression with endoscopic or percutaneous stenting is warranted. In addition, unresponsive PLA may actually be a manifestation of an underlying liver tumor.6 Although several of these factors did not reach statistical significance, a larger series of patients may provide the data necessary to avoid a type 2 statistical error. In summary, percutaneous drainage of PLAs associated with hepatobiliary malignancies is the primary treatment, but surgeons should be cognizant of those patients at risk for treatment failure. Poking pungent PLAs may not be treatment enough when only operative therapy will provide adequate drainage and perhaps diagnose underlying malignancies.

Intra-Abscess Administration of Antibiotics Through Ultrasound–Guided Percutaneous Catheter for the Treatment of Pyogenic Liver Abscess

Pyogenic liver abscess is a potentially life-threatening disease. The treatment of a pyogenic liver abscess usually involves ultrasound guided percutaneous drainage because of the poor penetration of the systemic administration of antibiotics inside the abscess. However, a sizable proportion of patients will necessitate surgical interventions, which involves high peri- and post-operative risks. Theoretically, the local instillation of antibiotics inside the pyogenic liver abscess fluid could achieve a high concentration of the antibiotic for a long period of time. This could be especially beneficial for time-dependent bactericidal antibiotics such as beta-lactams, because their bactericidal effectiveness depends on the amount of time that bacteria are exposed to the antibiotic. We are reporting two patients with complicated pyogenic liver abscesses, who were successfully treated with systemic antibiotics and local instillation of meropenem inside the cavities of the abscesses. These cases suggest that the local instillation of the beta-lactam antibiotics could be an effective and a safe strategy for the treatment of pyogenic liver abscesses that cannot be completely drained through an ultrasound guided percutaneous catheter.

Use of percutaneous drainage for treatment of pyogenic liver abscess

Use of percutaneous drainage for treatment of pyogenic liver abscess

Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China

In China, there are four types of liver abscesses (LAs) that meet the clinical criteria. Pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs) are two of the most common types of abscesses, followed by fungal liver abscesses (FLAs) and hydatid secondary liver abscesses (HsLAs). Diabetes mellitus (DM) is associated with the development of PLAs. However, there is a lack of population-based studies that have evaluated the underlying relationship between LAs (mainly PLAs and FLAs) and DM. We conducted a retrospective study based on a large population to identify the potential differences and factors that affect the mortality of PLA patients in DM and non-DM groups. Our results revealed that the prevalence of DM is 44.3% (158/357) in PLA patients and 35.3% (18/51) in FLA patients. Compared with the non-DM patients, statistically significant differences were found in DM patients according to symptomatology, clinical manifestations, laboratory findings, microbiological characteristics, antimicrobial resistance, clinical treatments and outcomes in relation to mortality. In addition, the status of antibiotic resistance to E. coli and K. pneumoniae, which were isolated from the patient samples, is severe in the area in which the study was conducted. Regarding the treatment of PLAs, our study indicated that broad-spectrum antimicrobial therapy and drug combinations should be recommended and initiated before the pathogens are cultured and identified. In the clinic, therapies that combine percutaneous drainage with antibiotics and surgery with antibiotics are the two most useful strategies for treating an LA. These two combined treatments resulted in satisfactory cure rates. In the DM and non-DM groups, the cure rates for percutaneous drainage with antibiotics were 90.3% and 92.0%, respectively, and the cure rates for surgery with antibiotics were 93.9% and 95.2%, respectively.

Comparison of laparoscopic and open surgery for pyogenic liver abscess with biliary pathology

To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess (PLA) with biliary pathology. From January 2004 to October 2010, 31 patients with PLA combined with biliary pathology meeting entry criteria received surgical management in our hospital. Of the 31 patients, 13 underwent laparoscopic surgery (LS group) and 18 underwent open surgery (OS group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, length of postoperative hospital stay, and abscess recurrence rate were retrospectively analyzed and compared between the two groups. All patients received systemic antibiotic therapy. Four patients underwent ultrasound-guided percutaneous catheter drainage before operation. Postoperative complications occurred in 5 patients (16.1%, 5/31) including 2 in the LS group and 3 in the OS group. One patient had retained calculus in the common bile duct and another had liver abscess recurrence in the OS group. No retained calculus and liver abscess recurrence occurred in the LS group. In the two groups, there was no mortality during the perioperative period. There were no significant differences in operation time, intraoperative blood loss and transfusion, postoperative complication rate and abscess recurrence rate between the two groups. Oral intake was earlier (1.9 ± 0.4 d vs 3.1 ± 0.7 d, P < 0.05) and length of postoperative hospital stay was shorter (11.3 ± 2.9 d vs 14.5 ± 3.7 d, P < 0.05) in the LS group than in the OS group. Laparoscopic surgery for simultaneous treatment of PLA and biliary pathology is feasible in selected patients and the therapeutic effect is similar to that of open surgery.

Clinical significance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess

To investigate the clinical significance of C-reactive protein (CRP) values in determining the endpoint of antibiotic treatment for liver abscess after drainage. The endpoints of antibiotic treatment in 46 patients with pyogenic liver abscess after complete percutaneous drainage were assessed by performing a retrospective study. After complete percutaneous drainage, normal CRP values were considered as the endpoint in 18 patients (experimental group), and normal body temperature for at least 2 wk were considered as the endpoints in the other 28 patients (control group). The duration of antibiotic treatment after complete percutaneous drainage was 15.83 ± 6.45 d and 24.25 ± 8.18 d for the experimental and the control groups, respectively (P = 0.001), being significantly shorter in the experimental group than in the control group. The recurrence rate was 0% for both groups. However, we could not obtain the follow-up data about 3 patients in the control group. CRP values can be considered as an independent factor to determine the duration of the antibiotic treatment for pyogenic liver abscess after complete percutaneous drainage.

Percutaneous Hepatic Abscess Drainage: Do Multiple Abscesses or Multiloculated Abscesses Preclude Drainage or Affect Outcome?

To compare the effectiveness of percutaneous abscess drainage in patients with pyogenic liver abscesses of the following types: single, single multiloculated, multiple, and multiple multiloculated. One hundred nine patients with 149 liver abscesses who underwent percutaneous drainage during an 11-year period were divided into a single abscess group and a multiple abscess group. Of the 109 patients, 54 had multiloculated abscesses and were divided into single and multiple multiloculated abscess groups. Technical success was defined as the ability to place the catheter within the abscess cavity and clinical success was defined as improvement in the patient's symptoms. Clinical findings, management strategy, complication rate, and success rate were analyzed. Technical success rates were 96% (82 of 85) for a single abscess and 96% (23 of 24) for multiple abscesses (P = 1.0). Clinical success was achieved in 74 of 85 patients (87%) with a single abscess and 22 of 24 patients (92%) with multiple abscesses (P = .729). Technical success rates were 94% (32 of 34) for a single multiloculated abscess and 95% (19 of 20) for multiple multiloculated abscesses (P = 1.0). Clinical success was achieved in 30 of 34 patients (88%) with a single multiloculated abscess and 18 of 20 patients (90%) with multiple multiloculated abscesses (P = 1). No significant difference in hospital stay was seen between single and multiple abscess groups (P = .373) or between single multiloculated and multiple multiloculated abscess groups (P = .180). There were no major complications or mortality related to the procedure. Percutaneous drainage is a safe and effective procedure in the treatment of pyogenic liver abscess, regardless of abscess complexity and/or multiplicity.