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Long Q, Zhao X, Chen C, Hao M, Qin X. Clinical features and risk factors for pyogenic liver abscess caused by multidrug-resistant organisms: A retrospective study. Virulence 2024; 15:2356680. [PMID: 38767562 PMCID: PMC11110708 DOI: 10.1080/21505594.2024.2356680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
The incidence rate of pyogenic liver abscess caused by multidrug-resistant bacteria has increased in recent years. This study aimed to identify the clinical characteristics and risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. We conducted a retrospective analysis of the clinical features, laboratory test results, and causes of pyogenic liver abscesses in 239 patients admitted to a tertiary hospital. Multivariable logistic regression was used to identify risk factors for multidrug resistance. Among patients with pyogenic liver abscesses, the rate of infection caused by multidrug-resistant organisms was observed to be 23.0% (55/239), with a polymicrobial infection rate of 14.6% (35/239). Additionally, 71 cases (29.7%) were associated with biliary tract disease. Patients with pyogenic liver abscesses caused by multidrug-resistant organisms had a significantly higher likelihood of polymicrobial infection and increased mortality (7/44 [15.9%] vs. 3/131 [2.3%]; p = .003). The Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.06-1.68), hospitalization (aOR: 10.34, 95% CI: 1.86-60.3) or an invasive procedure (aOR: 9.62; 95% CI: 1.66-71.7) within the past 6 months, and gas in the liver on imaging (aOR: 26.0; 95% CI: 3.29-261.3) were independent risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. A nomogram was constructed based on the risk factors identified. The nomogram showed high diagnostic accuracy (specificity, 0.878; sensitivity 0.940). Multidrug-resistant organisms causing pyogenic liver abscesses have specific characteristics. Early identification of patients at high risk of infection with multidrug-resistant organisms could help improve their management and enable personalized treatment.
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Affiliation(s)
- Qin Long
- Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Traditional Chinese Medicine College, Zhuzhou, Hunan, China
| | - Xiaoyu Zhao
- Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Chang Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Hunan Traditional Chinese Medicine College, Zhuzhou, Hunan, China
| | - Min Hao
- Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Xiaohua Qin
- Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
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Wendt S, Bačák M, Petroff D, Lippmann N, Blank V, Seehofer D, Zimmermann L, Lübbert C, Karlas T. Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital. Sci Rep 2024; 14:12972. [PMID: 38839980 PMCID: PMC11153614 DOI: 10.1038/s41598-024-63819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.
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Affiliation(s)
- Sebastian Wendt
- Hospital Hygiene Staff Unit, University Hospital Halle (Saale), Halle (Saale), Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | - Miroslav Bačák
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
- Institute for Medical Microbiology and Virology, Leipzig University Medical Center, Leipzig, Germany
| | - Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Medicine I, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Lisa Zimmermann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
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Xu Q, Liu C, Wu Z, Zhang S, Chen Z, Shi Y, Gu S. Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species. Heliyon 2024; 10:e29463. [PMID: 38638973 PMCID: PMC11024600 DOI: 10.1016/j.heliyon.2024.e29463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Background Pyogenic liver abscess (PLA) is a potentially life-threatening intra-abdominal infection. We compared the clinical features, treatments, and prognoses of patients who had Klebsiella pneumonia pyogenic liver abscess (KPPLA) and non-Klebsiella pneumonia pyogenic liver abscess (non-KPPLA). Methods A retrospective analysis was used to compare the medical records of KPPLA and non-KPPLA patients with positive pus cultures at a single hospital in China from January 2017 to December 2019. Results We examined 279 patients with definitively established PLA, 207 (74.2 %) with KPPLA, and 72 with non-KPPLA. The non-KPPLA group had a higher Charlson comorbidity index, longer hospital stay, longer duration of fever, and greater hospital costs. Multivariate analysis showed that alcohol intake (OR: 2.44, P = 0.048), cancer (OR: 4.80, P = 0.001), ICU admission (OR: 10.61, P = 0.026), resolution of fever OR: 1.04, P = 0.020), and a positive blood culture (OR: 2.87, P = 0.029) were independent predictors of primary treatment failure. Percutaneous needle aspiration (PNA) and pigtail catheter drainage (PCD) provided satisfactory outcomes, but PNA led to shorter hospital stays and reduced costs, especially in KPPLA patients whose abscesses were smaller than 10 cm. Conclusion KPPLA and non-KPPLA patients had some differences in comorbidities and treatment strategies, and non-KPPLA patients had a significantly worse prognosis.
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Affiliation(s)
- Qiaomai Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changhong Liu
- Department of Hepatology, The Fifth People's Hospital of Ganzhou, Ganzhou Institute of Hepatology, Ganzhou, China
| | - Zhengjie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shumeng Zhang
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Chessa S, Belfiori E, Mandis G, Urru E, Manconi G, Scuteri A. Bacteremia from streptococcus constellatus revealing a gastrointestinal stromal tumor. Gut Pathog 2024; 16:1. [PMID: 38178146 PMCID: PMC10765689 DOI: 10.1186/s13099-023-00593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Pyogenic Liver Abscesses (PLA) are the most common type of visceral abscess. They generally develop in a context of biliary disease or hematogenous seeding, but a complete diagnostic work-up is always required in order not to miss other important causes, including above all malignancies of the gastro-intestinal tract. CASE PRESENTATION Herein, we report a particular case of a 80 years-old immunocompetent woman hospitalized for sepsis. At the end of the diagnostic process, Streptococcus constellatus (Sc) was identified as the cause of sepsis, multiple PLA were found together with a previous unknown ileal malignancy. We speculated about a possible correlation among these three entities (i.e. sepsis from Sc, PLA and tumors). CONCLUSIONS Detection of Sc in blood should raise red flags in clinicians as aggressive clinical presentation are possible.
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Affiliation(s)
- Salvatore Chessa
- Post-Graduate Medical School of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Elena Belfiori
- Post-Graduate Medical School of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Giulia Mandis
- Post-Graduate Medical School of Internal Medicine, University of Cagliari, Cagliari, Italy
| | - Enrico Urru
- Division of Internal Medicine, University Hospital Monserrato (AOU), Cagliari, Italy
| | - Giovanna Manconi
- Division of Internal Medicine, University Hospital Monserrato (AOU), Cagliari, Italy
| | - Angelo Scuteri
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Division of Internal Medicine, University Hospital Monserrato (AOU), Cagliari, Italy.
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Canouï E, Rossi G, Nguyen Y, Lafont E, Rossi B, Roux O, Dokmak S, Bert F, Leflon-Guibout V, Fantin B, Lefort A. Analysis of 15 cases from a monocentric cohort of 307 liver abscesses. Mycoses 2023; 66:984-991. [PMID: 37534436 DOI: 10.1111/myc.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Out of the context of haematological patients, Candida sp. is rarely retrieved from pyogenic liver abscesses (PLA). OBJECTIVES Our objective was to assess the risk factors for occurrence, and clinical, microbiological characteristics, management and outcome of Candida pyogenic liver abscesses (C-PLA). PATIENTS/METHODS We retrospectively analysed C-PLA cases and compared them to pyogenic liver abscesses exclusively due to bacteria (B-PLA) included in our monocentric database on liver abscesses. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence after an initial cure, or death within 3 months after diagnosis. RESULTS Between 2010 and 2018, 15 C-PLA and 292 B-PLA were included. All C-PLA had a biliary origin and were polymicrobial. All patients with C-PLA had at least one comorbidity at risk for Candida infection and 7 (53.3%) presented with sepsis requiring an admission in intensive care unit. Median duration of antifungal treatment was 42 days [24-55]. In multivariate analysis, compared with B-PLA, a medical history of malignancy (OR 4.16; 95%CI 1.15-18.72) or liver abscess (OR 7.39; 95%CI 2.10-26.62), and sepsis with severity criteria (OR 3.52; 95%CI 1.07-11.90) were independently associated with the occurrence of C-PLA. In multivariate analysis, C-PLA was associated with a higher risk of recurrence (HR 3.08; 95%CI 1.38-11.22). CONCLUSION Candida liver abscesses in non-neutropenic is a rare and severe disease. The high rate of recurrence should lead to discuss a more intensive treatment.
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Affiliation(s)
- Etienne Canouï
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Geoffrey Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Emmanuel Lafont
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Benjamin Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Olivier Roux
- Department of Hepatology, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Safi Dokmak
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Frédéric Bert
- Department of microbiology, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Véronique Leflon-Guibout
- Department of microbiology, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Bruno Fantin
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
- IAME, UMR1137, Université Paris-Cité, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
- IAME, UMR1137, Université Paris-Cité, Paris, France
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6
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Kimseng H, Rossi G, Danjean M, Jimenez-Araya B, Chaligne C, Galy A, Souhail B, Bert F, Leflon V, Fihman V, Caillault A, Demontant V, Seng S, Trawinski E, N 'Debi M, Boizeau L, Jacquier H, Ronot M, Reizine E, Le Roy V, Lefort A, Rodriguez C, Lepeule R, Woerther PL. Evaluation of the contribution of shotgun metagenomics in the microbiological diagnosis of liver abscesses. J Infect 2023; 87:365-372. [PMID: 37604210 DOI: 10.1016/j.jinf.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Shotgun metagenomics (SMg) sequencing has gained a considerable interest, as it enables the detection of any microorganisms through a single analysis. Due to the limitations of standard microbiological approaches, the microbial documentation of liver abscesses (LA), which is crucial for their medical management, can be difficult. Here we aimed to compare the performance of SMg with standard approaches for the microbiological documentation of LA. METHODS In this retrospective study conducted at two centers, we compared the results of standard microbiology with metagenomics analysis of consecutive LA samples. For samples tested positive for Klebsiella pneumoniae, we compared the analysis of virulence and resistance genes using metagenomics data to whole-genome sequencing of corresponding isolates obtained in culture. RESULTS Out of the 62 samples included, standard approaches and SMg yielded documentation in 80.6% and 96.8%, respectively. In 37.1% (23/62) of cases, both methods showed identical results, whereas in 43.5% (27/62) of cases, the samples were positive by both methods, but SMg found additional species in 88.9% (24/27), mostly anaerobes. When the standard approaches were negative, the SMg was able to detect microorganisms in 80.0% of cases (8/10). Overall, SMg identified significantly more microorganisms than culture (414 vs.105; p<0.05). K. pneumoniae genome analysis was able to detect resistance and virulence genes with a level of sensitivity depending on the depth of sequencing. DISCUSSION Overall, we showed that SMg had better performance in detecting and identifying microorganisms from LA samples and could help characterizing strain's resistome and virulome. Although still costly and requiring specific skills and expensive equipment, MGs methods are set to expand in the future.
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Affiliation(s)
- Hadrien Kimseng
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Geoffrey Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Maxime Danjean
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Bryan Jimenez-Araya
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Camille Chaligne
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Adrien Galy
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; Antimicrobial Stewardship Team, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France
| | - Bérénice Souhail
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; Antimicrobial Stewardship Team, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France
| | - Frédéric Bert
- Department of Microbiology, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Véronique Leflon
- Department of Microbiology, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Vincent Fihman
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | | | | | - Sarah Seng
- NGS Platform, IMRB Institute, Créteil, France
| | | | | | | | - Hervé Jacquier
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France
| | - Edouard Reizine
- Department of Radiology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Vincent Le Roy
- Department of Hepatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Agnès Lefort
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP Nord-Université Paris Cité, Clichy, France; IAME, UMR1137, Université Paris-Cité, Paris, France
| | - Christophe Rodriguez
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; INSERM U955, IMRB Institute, Créteil, France; NGS Platform, IMRB Institute, Créteil, France
| | - Raphaël Lepeule
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; Antimicrobial Stewardship Team, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France
| | - Paul-Louis Woerther
- Department of Microbiology, Henri Mondor Hospital, AP-HP, University of Paris-Est, Créteil, France; EA 7380 Dynamyc, EnvA, UPEC, University of Paris-Est, Créteil, France; NGS Platform, IMRB Institute, Créteil, France.
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Abstract
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.
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Affiliation(s)
- John C Lam
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William Stokes
- Provincial Laboratory for Public Health, Alberta Precision Laboratories, Calgary
- Department of Pathology and Laboratory Medicine, University of Alberta
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Dauny V, Dioguardi-Burgio M, Leflon-Guibout V, Bert F, Roux O, Houzé S, Lefort A, Rossi G. [Clinical and radiological differences between amoebic and pyogenic liver abscess: A case-control study]. Rev Med Interne 2023; 44:472-478. [PMID: 37105864 DOI: 10.1016/j.revmed.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Amoebic liver abscess (ALA) is the fourth cause of mortality by parasitic infection. This study aimed to assess clinical, radiological and therapeutic characteristics of patients admitted for amoebic liver abscess compared to pyogenic abscess in a French digestive tertiary care-centre. MATERIAL AND METHOD The charts of patients hospitalized for a liver abscess between 2010 and 2020 were retrospectively assessed then separated in two groups: amoebic liver abscess and pyogenic liver abscess from portal underlying cause. Clinical and radiological data were collected for univariate comparison. RESULTS Twenty-one patients were hospitalized during the time of the study for ALA, and 21 patients for pyogenic liver abscess with a portal mechanism. All patients hospitalized for ALA lived in and/or had travelled recently in an endemic area. In comparison with patients hospitalized for pyogenic abscess, patients admitted for ALA were younger (44years old vs. 63years old, P<0.001), had less comorbidities (5% vs. 43% of patients with at least one comorbidity, P<0.01), a longer median duration of symptoms (10days vs. 3days, P=0.015), abdominal pain (86% vs. 52%, P=0.019), and a slighter leucocytosis (9600G/L vs. 15,500G/L, P=0.041) were more frequent. On the abdominal tomodensitometry, density of ALA was higher (34 vs. 25 UH, P<0.01), associated with a focal intra-hepatic biliary dilatation and less often multiloculated. CONCLUSION While rare in western countries, amoebic liver abscess care should not be underestimated. The presence of a solitary liver abscess of intermediate density on computed tomography, occurring on a patient returning from an endemic zone should lead the physician to a possible diagnosis of ALA.
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Affiliation(s)
- Vincent Dauny
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France.
| | - Marco Dioguardi-Burgio
- Service de radiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France; Inserm U1149, « centre de recherche sur l'inflammation » (CRI), université Paris Cité, 75018 Paris, France
| | - Véronique Leflon-Guibout
- Laboratoire de microbiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Frédéric Bert
- Laboratoire de microbiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Olivier Roux
- Service d'hépatologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Sandrine Houzé
- Service de parasitologie, hôpital Bichat, AP-HP, 75018 Paris, France; IRD, MERIT, université Paris Cité, 75006 Paris, France
| | - Agnès Lefort
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France; Inserm, IAME, UMR1137, université Paris Cité, Paris, France
| | - Geoffrey Rossi
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
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9
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Bläckberg A, Jönsson A, Svensson E, Sunnerhagen T, Kiasat A, Ljungquist O. A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess. Open Forum Infect Dis 2023; 10:ofad352. [PMID: 37547858 PMCID: PMC10400158 DOI: 10.1093/ofid/ofad352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/08/2023] [Indexed: 08/08/2023] Open
Abstract
Background Pyogenic liver abscess (PLA) is a rare entity that is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (odds ratio [OR], 2.0 [95% confidence interval {CI}, 1.1-3.9]), malignancy (OR, 3.7 [95% CI, 1.9-7.1]), liver failure (OR, 6.3 [95% CI, 2.7-14.5]), and polymicrobial findings (OR, 3.8 [95% CI, 2.2-6.9]) were associated with death within 90 days (P < .05). Male sex (OR, 2.1 [95% CI, 1.2-3.6]), malignancy (OR, 2.1 [95% CI, 1.3-3.6]), age (64-74 years: OR, 2.5 [95% CI, 1.3-4.8]), and chronic liver disease (OR, 3.0 [95% CI, 1.4-6.5]) were associated with the risk of subsequent PLA (P ≤ .01). Conclusions Identifying different clinical variables associated with an unfavorable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.
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Affiliation(s)
- Anna Bläckberg
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
| | - Astrid Jönsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Lund, Sweden
| | - Ali Kiasat
- Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Ljungquist
- Correspondence: Anna Bläckberg, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden (); Oskar Ljungquist, MD, PhD, Division of Infection Medicine, Department of Clinical Sciences, Lund University, 22100 Lund, Sweden ()
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