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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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Hu D, Chen W, Wu J, Luo X, Yu L, Qu Y, Zhang X, Zhang J, Ma B. Coexistence of c-rmpA with p-rmpA and p-rmpA2 rather than excessive siderophores confers higher virulence in K1 Klebsiella pneumoniae. Pathology 2023; 55:1004-1012. [PMID: 37802741 DOI: 10.1016/j.pathol.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 10/08/2023]
Abstract
Pyogenic liver abscess (PLA), which is particularly endemic in East Asia, is a relatively common and fatal infectious disease. Over the last 30-40 years, Klebsiella pneumoniae has replaced Escherichia coli as the dominant and overwhelming pathogen. To investigate the survival advantage of serotype K1 K. pneumoniae, we determined sequence types (STs), serotypes, and 11 virulence genes (allS, entB, irp2, iroN, iucA, fimH, mrkD, p-rmpA2, c-rmpA, p-rmpA, and peg-344). Virulence genes c-rmpA, p-rmpA, and p-rmpA2 in K. pneumoniae NTUH-K2044, which all confer hypercapsule and consequent hypervirulence, were deleted individually, and the consequent effects were evaluated. The lethality of various K1 K. pneumoniae strains was compared by using the Galleria mellonella model. In total, 31 K1 K. pneumoniae strains causing PLA and 30 causing non-PLA were identified. A significantly higher rate of c-rmpA was presented in PLA-derived K. pneumoniae strains than in non-PLA-derived strains. Similar ST23 (which dominates K1 strains) and string test-positive rates were observed in the two groups. Deletion of c-rmpA, p-rmpA, and p-rmpA2 individually did not confer significant effects on morphologies, such as positive string test, hypercapsule, and growth speed. Δc-rmpA presented weaker expressions of p-rmpA/p-rmpA2 than NTUH-K2044 and showed a higher expression of manC than Δp-rmpA and Δp-rmpA2. Three rmpAs conferred more virulence than one or two rmpAs, which presented an equally lethal effect in K1 K. pneumoniae. Klebsiella pneumoniae strains (H19 and H34) with the same genetic backgrounds except for siderophores showed equal virulence, but were less virulent than strain NTUH-K2044. Thus, the coexistence of c-rmpA with p-rmpA and p-rmpA2 enhances the lethality of K1 K. pneumoniae strains and the development of PLA. Excessive siderophores are not vital for the hypervirulence of K1 K. pneumoniae strains, although K1 strains usually harbour them on a molecular basis.
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Affiliation(s)
- Dakang Hu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Wenjie Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinzuan Wu
- Department of Clinical Laboratory, Pingyang Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinhua Luo
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Lianhua Yu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Ying Qu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Xijiang Zhang
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jin Zhang
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China.
| | - Bin Ma
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA, Australia.
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Chen Y, Gong Y, Song B, Du Y, Cai K. Pyogenic liver abscess complicated with endogenous endophthalmitis caused by Klebsiella pneumoniae: A case report and Literature Review. Immun Inflamm Dis 2023; 11:e943. [PMID: 37506152 PMCID: PMC10373569 DOI: 10.1002/iid3.943] [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: 03/31/2023] [Revised: 06/08/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE Pyogenic liver abscess (PLA) is a common surgical infectious disease caused by various pathogens. Klebsiella pneumoniae is a relatively recent cause, often affecting patients with low immunity. Endogenous endophthalmitis (EE), a rare and serious complication of PLA, may appear with eye symptoms before PLA. By reviewing a case of Klebsiella pneumoniae-induced PLA complicated with EE, we want to summarize the information about the characteristics, causes, and complications of PLA based on the literature review. METHODS This case report describes a 37-year-old male who had fever high to 39°C for 10 days experienced blurred vision followed by nonlight perception vision. He reported a history of diabetes irregularly taking oral medications and insulin therapy. Imaging examination found a large low-density area in the right lobe of the liver with an unclear border and vague surrounding fat gap. The blood culture was not positive. The culture of the drainage fluid from the liver puncture showed Klebsiella pneumonia. Blood and liver puncture drainage fluid were sent for microbial high-throughput gene detection with next-generation sequencing technology (NGS), which confirmed the diagnosis of Klebsiella pneumoniae-induced PLA complicated with EE. RESULTS The patient's surgical incision had healed well at discharge, and he could feel light at his left eye. But the patient was lost to follow-up since the third month after discharge. CONCLUSION By reviewing this case and summarize the information about the characteristics, causes, and complications of PLA based on the literature review, we concluded that it is necessary to promptly perform liver puncture drainage and empirically use antibiotics for patients with PLA, especially those with poor glycemic control, to avoid serious complications such as EE.
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Affiliation(s)
- Yunjiang Chen
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yanchun Gong
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Bei Song
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yueling Du
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Kaiyu Cai
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Guo Y, Wang H, Liu Z, Chang Z. Comprehensive analysis of the microbiome and metabolome in pus from pyogenic liver abscess patients with and without diabetes mellitus. Front Microbiol 2023; 14:1211835. [PMID: 37426007 PMCID: PMC10328747 DOI: 10.3389/fmicb.2023.1211835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Pyogenic liver abscess (PLA) patients combined with diabetes mellitus (DM) tend to have more severe clinical manifestations than without DM. The mechanism responsible for this phenomenon is not entirely clear. The current study therefore aimed to comprehensively analyze the microbiome composition and metabolome in pus from PLA patients with and without DM, to determine the potential reasons for these differences. Methods Clinical data from 290 PLA patients were collected retrospectively. We analyzed the pus microbiota using 16S rDNA sequencing in 62 PLA patients. In addition, the pus metabolomes of 38 pus samples were characterized by untargeted metabolomics analysis. Correlation analyses of microbiota, metabolites and laboratory findings were performed to identify significant associations. Results PLA patients with DM had more severe clinical manifestations than PLA patients without DM. There were 17 discriminating genera between the two groups at the genus level, among which Klebsiella was the most discriminating taxa. The ABC transporters was the most significant differential metabolic pathway predicted by PICRUSt2. Untargeted metabolomics analysis showed that concentrations of various metabolites were significantly different between the two groups and seven metabolites were enriched in the ABC transporters pathway. Phosphoric acid, taurine, and orthophosphate in the ABC transporters pathway were negatively correlated with the relative abundance of Klebsiella and the blood glucose level. Discussion The results showed that the relative abundance of Klebsiella in the pus cavity of PLA patients with DM was higher than those without DM, accompanied by changes of various metabolites and metabolic pathways, which may be associated with more severe clinical manifestations.
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Hu D, Chen W, Wang W, Tian D, Fu P, Ren P, Mu Q, Li G, Jiang X. Hypercapsule is the cornerstone of Klebsiella pneumoniae in inducing pyogenic liver abscess. Front Cell Infect Microbiol 2023; 13:1147855. [PMID: 37065211 PMCID: PMC10102340 DOI: 10.3389/fcimb.2023.1147855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
PurposeTo investigate the mechanisms of Klebsiella pneumoniae-induced pyogenic liver abscess (PLA).MethodsForty-three K. pneumoniae strains from PLAs and 436 from non-PLAs were collected. Their differences were compared for virulence genes and factors, sequence types, and serotypes. Virulence genes wzi, wzy-K1, and wzi+wzy-K1 were deleted in K. pneumoniae NTUH-K2044. Various analyses, such as transmission electron microscopy, neutrophil killing tests, and mouse lethality tests, were used to confirm the consequent changes.ResultsDifferences were found between K. pneumoniae strains from PLA and non-PLA samples for virulence genes and factors, including metabolism genes (allS and peg-344), capsular polysaccharide (CPS)-synthesis channel gene (wzy-K1), CPS-regulating genes (p-rmpA, p-rmpA2, and c-rmpA), and siderophore genes (iucA and iroN). When wzy-K1 was positive, the difference between PLA and non-PLA samples was only observed with c-rmpA. Δwzi, Δwzy-K1, and ΔwziΔwzy-K1 strains reverted to hypovirulence. In the Kupffer cell stimulation assay, interleukin (IL)-6, IL-12, IL-10, and transforming growth factor-β secretions were found to be equivalent in NTUH-K2044, Δwzi, Δwzy-K1, and ΔwziΔwzy-K1 groups. Lower IL-1β and higher tumor necrosis factor-α secretions were observed for Δwzi, Δwzy-K1, and ΔwziΔwzy-K1.ConclusionsHypercapsule production is the cornerstone of hypervirulence, regardless of exopolysaccharides. K1 K. pneumoniae-induced PLA may decrease core inflammatory cytokines rather than increase anti-inflammatory cytokines. Exopolysaccharides could also attenuate the inflammatory response to aid in the immune escape of K. pneumoniae.
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Affiliation(s)
- Dakang Hu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjie Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Weiwen Wang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongxing Tian
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Pan Fu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Microbiology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Ping Ren
- Zhejiang Provincial Demonstration Centre of Laboratory Medicine Experimental Teaching, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qing Mu
- School of Pharmacy, Fudan University, Shanghai, China
| | - Gang Li
- Department of Laboratory Medicine, Jinshan Hospital of Fudan University, Shanghai, China
- *Correspondence: Gang Li, ; Xiaofei Jiang,
| | - Xiaofei Jiang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Gang Li, ; Xiaofei Jiang,
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Svensson E, Jönsson A, Bläckberg A, Sunnerhagen T, Kiasat A, Ljungquist O. Increasing incidence of pyogenic liver abscess in Southern Sweden: a population-based study from 2011 to 2020. Infect Dis (Lond) 2023; 55:375-383. [PMID: 36943906 DOI: 10.1080/23744235.2023.2190813] [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] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease, and estimates suggest a gradual increase in the incidence during the last decades. The primary aim of this study was to report the incidence, trend and aetiology of PLA during a decade in Southern Sweden. METHODS This was a population-based observational cohort study between 2011 and 2020 in Skåne, Southern Sweden. Data were retrieved from the Swedish National Board of Health and Welfare for all individuals diagnosed with liver abscess (K750) according to ICD-10 (International Statistical Classification of Diseases, 10th revision). RESULTS A total of 456 episodes of PLA occurred in 364 patients during the study period. The median age of the first PLA episode was 71 years (range 3-97) and 57% (n = 206) were men. The mean incidence of all patients was 3.4/100,000 person-years (range 1.8-5.2). The incidence increased almost three times, from 1.8/100,000 person-years in 2011 to 5.2/100,000 person-years in 2020. Streptococcus species, Escherichia coli and Klebsiella species accounted for the vast majority of both mono- and polymicrobial findings in both blood and local abscess cultures. 16s rDNA added information about aetiology in 37% of episodes. CONCLUSION The incidence of PLA increased during the study period, and Streptococcus spp., Klebsiella spp. and E. coli dominated both blood and local cultures. Despite antimicrobial therapy, pathogens could be found in local abscess cultures several weeks into treatment. Increased use of 16s rDNA in the management of PLA could be beneficial.
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Affiliation(s)
- Emma Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Astrid Jönsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Bläckberg
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, 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, Region Skåne, 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
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
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Liu Y, Liu J, Fu L, Jiang C, Peng S. Demographics and Clinical Outcomes of Culture-Positive versus Culture-Negative Pyogenic Liver Abscess in an Asian Population. Infect Drug Resist 2023; 16:903-911. [PMID: 36814829 PMCID: PMC9940495 DOI: 10.2147/idr.s395428] [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: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
Objective Despite its high case-fatality risk, pyogenic liver abscess (PLA) lacks clear management guidelines in patients with negative microbial cultures. Our aim was to evaluate differences in clinical characteristics between patients with culture-negative liver abscess (CNLA) and those with culture-positive liver abscess (CPLA), and identify differences in the main causative pathogen. Methods In this study, we retrospectively collected medical records of PLA patients admitted to a teaching hospital from January 2010 to December 2019. Results In total, 324 PLA patients were enrolled in this study. Of these, 202 (62.3%) cases were confirmed cultural positive, including 109 patients (54%) and 20 (9.9%) patients infected with Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E.coli), respectively. Patients in the CPLA group were older (p=0.029) and had higher prevalence of abscesses larger than 5 cm in diameter (p = 0.003), gas-forming rate (p = 0.016), and percutaneous drainage (p < 0.001) compared with CNLA group. Patients with CPLA had significantly longer hospitalizations than those with CNLA (p = 0.010). Nevertheless, there was no significant difference in in-hospital mortality between the two groups (p = 0.415). Compared with patients with E. coli, those with K. pneumoniae had higher incidence of diabetes mellitus (p = 0.041), solitary abscess (p < 0.001), localization in the right hepatic lobe (p = 0.033), abscess size larger than 5 cm (p < 0.001) and percutaneous drainage (p = 0.002), but mortality was not significantly different (p = 1.000). Conclusion No significant difference in in-hospital mortality was found between patients with CNLA and those with CPLA group. However, clinical characteristics and management were different between the main causative pathogens, including K. pneumoniae and E. coli.
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Affiliation(s)
- Yao Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Jinqing Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Chuan Jiang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Correspondence: Shifang Peng, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China, Email
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JinHua C, YaMan L, Jian L. Double pigtail tube drainage for large multiloculated pyogenic liver abscesses. Front Surg 2023; 9:1106348. [PMID: 36713673 PMCID: PMC9877412 DOI: 10.3389/fsurg.2022.1106348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Background This study aims to investigate the efficacy and safety of double pigtail tube drainage compared with single pigtail tube drainage for the treatment of multiloculated pyogenic liver abscesses greater than 5 cm. Patients and Methods This study retrospectively analyzed patients with pyogenic liver abscess admitted in the Affiliated Hospital of Chengde Medical College between May 2013 and May 2021. Patients with pyogenic liver abscess more than 5 cm in size, who underwent drainage of the abscess with either double pigtail or single pigtail tube, were included. Results A total of 97 patients with pyogenic liver abscesses larger than 5 cm were studied. These included 34 patients with double pigtail tube drainage and 63 patients with single pigtail tube drainage. The postoperative hospital stay (13.39 ± 4.21 days vs. 15.67 ± 7.50 days; P = 0.045), and time for removal of the catheter (17.23 ± 3.70 days vs. 24.11 ± 5.83 days; P = 0.038) were lower in the double pigtail tube group compared with the single pigtail tube group. The rate of reduction, in three days, of c-reactive protein levels was 26.61 ± 14.11 mg/L/day in the double pigtail tube group vs. 20.06 ± 11.74 mg/L/day in the single pigtail tube group (P = 0.025). The diameter of the abscess cavity at discharge was 3.1 ± 0.07 cm in the double pigtail tube group as compared with 3.7 ± 0.6 cm in the single pigtail tube group (P = 0.047). There was no bleeding in any of the patients despite abnormal coagulation profiles. There was no recurrence of abscess within six months of discharge and no death in the double pigtail tube group. Conclusion: Double pigtail tube drainage treatment in multiloculated pyogenic liver abscesses greater than 5 cm in size, is safe and effective.
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Affiliation(s)
- Cui JinHua
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Liu YaMan
- Department of Gynaecology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Li Jian
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China,Correspondence: Li Jian
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Nie S, Lin D, Li X. Clinical characteristics and management of 106 patients with pyogenic liver abscess in a traditional Chinese hospital. Front Surg 2023; 9:1041746. [PMID: 36684358 PMCID: PMC9852512 DOI: 10.3389/fsurg.2022.1041746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023] Open
Abstract
This is a retrospective study of clinical data from 106 patients with pyogenic liver abscess (PLA) treated in a traditional Chinese hospital during the eight years preceding this publication. We aimed to provide evidence to improve the diagnosis accuracy and the treatment strategies for PLAs. We collected records of patients treated at the Guangxing Hospital, which is affiliated to the Zhejiang Traditional Chinese University in Hangzhou, and we collected their general background information, laboratory and imaging features, and clinical manifestations and outcomes to perform a retrospective analysis. Diabetes mellitus (45.3%, 48/106), biliary calculi (36.8%, 39/106), and history of abdominal surgery (15.1%, 16/106) were the three most common PLA risk factors present in our cohort. Fever and chills (95.3%, 101/106), right upper quadrant pain/epigastric discomfort (68.9%, 73/106), nausea and vomiting (38.8%, 41/106), and cough and sputum (14.2%, 15/106) were the most common clinical manifestations of PLA. Most patients had the abscesses in the right liver lobe, and the most commonly found bacteria were Klebsiella pneumoniae (54.8%, 42/76), Escherichia coli (35.1%, 27/76), and Streptococcus pneumoniae (3.9%, 3/76). Liver Doppler ultrasound is a conventional and effective method to identify liver abscesses. Most patients were treated using a percutaneous puncture under B-ultrasound guidance. Most patients (n = 104 or 98.1%) were cured, one patient (0.9%) died, and one was discharged with multiple abscesses post treatment.
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Affiliation(s)
- ShiJiao Nie
- Department of Hospital Infection Management, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Da Lin
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - XiaoWen Li
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China,Correspondence: XiaoWen Li
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Chen Y, Lai X, Zhu Y, Wang M, He Y. Changes in clinical and CT manifestations related to liver abscesses in patients with vs. without basic diabetes mellitus before and after CT-guided interventional therapy: An observational study. Clinics (Sao Paulo) 2023; 78:100164. [PMID: 36657253 PMCID: PMC9868336 DOI: 10.1016/j.clinsp.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To explore differences in the changes of clinical and CT manifestations related to liver abscess before and after CT-guided interventional therapy between patients with and without Diabetes Mellitus (DM). MATERIALS AND METHODS Fifty-eight consecutive patients with liver abscesses were retrospectively enrolled in this study. All patients underwent upper abdominal contrast-enhanced CT scans before and after CT-guided interventional therapy. They were divided into two groups including the DM group (n=30) and the Non-DM group (n=28) if the liver abscess occurred in patients with and without DM, respectively. The changes in the clinical and CT manifestations related to liver abscess after CT-guided interventional therapy in both groups were statistically analyzed. RESULTS After CT-guided interventional therapy, the length of hospital stay, white blood cell recovery time and drainage tube removal time in the DM group were longer than in the Non-DM group (all p-values < 0.05). The incidence of postoperative complications in the DM group was higher than in the Non-DM group (p < 0.05). As shown on CT, the postoperative reduced percentage of maximum diameter of abscess cavity and the reduction rate of edema band surrounding the liver abscess in the DM group were smaller than in the Non-DM group (both p-values < 0.05). The time intervals of the previous characteristic changes on CT before and after interventional therapy in the DM group were longer than in the Non-DM group (all p-values < 0.05). CONCLUSIONS The liver abscesses patients with DM could not have a faster recovery and better therapeutic effect than those without DM after the CT-guided interventional therapy.
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Affiliation(s)
- Yuxiang Chen
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xunfu Lai
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yuping Zhu
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Mengting Wang
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yulin He
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China.
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11
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Tang L, Wang H, Cao K, Li Y, Li T, Huang Y, Xu Y. Epidemiological Features and Impact of High Glucose Level on Virulence Gene Expression and Serum Resistance of Klebsiella pneumoniae Causing Liver Abscess in Diabetic Patients. Infect Drug Resist 2023; 16:1221-1230. [PMID: 36879852 PMCID: PMC9985391 DOI: 10.2147/idr.s391349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/18/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacterium that is predominantly associated with liver abscesses in global diabetic patients. High levels of glucose in the surrounding of K. pneumonia increase its pathogenicity including capsular polysaccharide (CPS) and fimbriae. Other important virulent factors include outer membrane protein A (ompA) and regulator mucoid phenotype A (rmpA). The objective of this investigation was to elucidate the effects of high glucose on rmpA and ompA gene expression and serum resistance of K. pneumoniae causing liver abscess. Patients and Methods The clinical history of 57 patients suffering from K. pneumoniae-caused liver abscesses (KLA) was acquired and their clinical and laboratory manifestations in the presence or absence of diabetes were analyzed. The antimicrobial susceptibility, serotypes, and virulence genes were tested. Clinical isolates of 3 serotype-K1 hypervirulent K. pneumoniae (hvKP) were used to detect the effect of exogenous high glucose on rmpA, ompA, and clbB genes expression, and bacterial serum resistance. Results KLA patients with diabetes showed higher C-reactive protein (CRP) compared to non-diabetic KLA patients. Furthermore, the diabetic group showed increased incidences of sepsis and invasive infections, and their length of hospital stay was also prolonged. Pre-incubation of K. pneumoniae in high glucose (0.5%) concentration up-regulated rmpA, ompA, and clbB genes expression. However, cAMP supplementation, which was inhibited by environmental glucose, reversed the increase of rmpA and ompA in a cAMP-dependent manner. Moreover, hvKP strains incubated in high glucose also exhibited enhanced protection from serum killing. Conclusion High glucose levels reflected by poor glycemic control has increased gene expression of rmpA and ompA in hvKP by the cAMP signaling pathway and enhanced its resistance to serum killing, thus providing a new and reasonable explanation for the high incidences of sepsis and invasive infections in KLA patients with diabetes.
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Affiliation(s)
- Ling Tang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Hui Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Kangli Cao
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yajuan Li
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Tingting Li
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Ying Huang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yuanhong Xu
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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12
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Liu YM, Ren YQ, Song SL, Zheng CS. Pyogenic liver abscess in non-liver cancer patients and liver cancer patients treated with TACE: Etiological characteristics, treatment, and outcome analysis. Kaohsiung J Med Sci 2023; 39:87-94. [PMID: 36354204 DOI: 10.1002/kjm2.12613] [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: 05/24/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Clinical, laboratory, and microbiological features, clinical outcomes, and pyogenic liver abscess (PLA) prognosis evaluation in non-liver cancer (Non-LC) and liver cancer patients treated with transarterial chemoembolization (TACE, LC-TACE). Clinical data of 48 consecutive PLA patients from January 2016 to December 2020 were retrospectively analyzed. Mortality between two PLA patient groups were compared, and mortality risk factors were evaluated. A total of 48 PLA patients (31 males and 17 females) from January 2016 to December 2020 met the study's inclusion criteria. There were 32 and 16 patients in the Non-LC and LC-TACE groups, respectively. Positive pus culture rate in the Non-LC group was 87.5% and positive pus culture rate in LC-TACE group was 81.3%. In the Non-LC group, 28 patients improved after treatment, 1 patient did not improve, and 3 patients died during hospitalization, with a 9.4% mortality rate. In the LC-TACE group, nine patients improved after treatment, three patients did not improve, and four patients died during hospitalization, with a 25% mortality rate. The Non-LC group cure time was 37.4 ± 23.1 days, while the LC-TACE group was 91.5 ± 49.7 days. PLA of the Non-LC group and the LC-TACE group were different in terms of pathogenic bacteria and cure time, and so on. A more comprehensive treatment should be considered for PLA after TACE.
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Affiliation(s)
- Yi-Ming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yan-Qiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
| | - Song-Lin Song
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
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13
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Dai P, Hu D. The making of hypervirulent Klebsiella pneumoniae. J Clin Lab Anal 2022; 36:e24743. [PMID: 36347819 PMCID: PMC9757020 DOI: 10.1002/jcla.24743] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/01/2022] [Accepted: 10/09/2022] [Indexed: 10/08/2023] Open
Abstract
Klebsiella pneumoniae is a notorious bacterium in clinical practice. Virulence, carbapenem-resistance and their convergence among K. pneumoniae are extensively discussed in this article. Hypervirulent K. pneumoniae (HvKP) has spread from the Asian Pacific Rim to the world, inducing various invasive infections, such as pyogenic liver abscess, endophthalmitis, and meningitis. Furthermore, HvKP has acquired more and more drug resistance. Among multidrug-resistant HvKP, hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP), and carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP) are both devastating for their extreme drug resistance and virulence. The hypervirulence of HvKP is primarily attributed to hypercapsule, macromolecular exopolysaccharides, or excessive siderophores, although it has many other factors, for example, lipopolysaccharides, fimbriae, and porins. In contrast with classical determination of HvKP, that is, animal lethality test, molecular determination could be an optional and practical method after improvement. HvKP, including Hv-CRKP and CR-HvKP, has been progressing. R-M and CRISPR-Cas systems may play pivotal roles in such evolutions. Hv-CRKP and CR-HvKP, in particular the former, should be of severe concern due to their being more and more prevalent.
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Affiliation(s)
- Piaopiao Dai
- Department of Laboratory MedicineTaizhou Municipal HospitalTaizhouChina
| | - Dakang Hu
- Department of Laboratory MedicineTaizhou Municipal HospitalTaizhouChina
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14
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Zeng X, Luo H, Yang P. Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study. Medicine (Baltimore) 2022; 101:e31745. [PMID: 36397374 PMCID: PMC9666222 DOI: 10.1097/md.0000000000031745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Xintao Zeng
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- * Correspondence: Pei Yang, Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China (e-mail: )
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15
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Wendt S, Lübbert C, Karlas T. Klebsiellen-Leberabszess. ZEITSCHRIFT FÜR GASTROENTEROLOGIE 2022. [DOI: 10.1055/a-1801-3748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Ko DG, Park JW, Kim JH, Jung JH, Kim HS, Suk KT, Jang MK, Park SH, Lee MS, Kim DJ, Kim SE. Platelet-to-White Blood Cell Ratio: A Feasible Biomarker for Pyogenic Liver Abscess. Diagnostics (Basel) 2022; 12:diagnostics12102556. [PMID: 36292245 PMCID: PMC9600737 DOI: 10.3390/diagnostics12102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
The platelet-to-white blood cell ratio (PWR) has been reported to predict the severity of patients with various diseases. However, no previous studies have assessed the use of the PWR as a prognostic marker for pyogenic liver abscesses (PLA). This observational retrospective study was performed between January 2008 and December 2017, including 833 patients with PLA from multiple centers. The enrolled patients, on average, had a PWR of 17.05, and 416 patients had a PWR lower than 17.05. A total of 260 patients (31.2%) with PLA showed complications of metastatic infection, pleural effusion and abscess rupture. A low PWR level was identified as a strong risk factor for metastatic infection and pleural effusion. The low PWR group also had a longer hospital stay. In the multivariate analysis, old age, anemia, albumin and CRP levels and unidentified pathogens were significant factors for low PWR levels. A low PWR, old age, male sex, abscess size, albumin, ALP and unidentified causative pathogens showed significant associations with a hospital stay longer than 28 days. As a result, PLA patients presenting with a low PWR were shown to have more complications and a poor prognosis. Considering its cost-effectiveness, PWR could be a novel biomarker used to predict a prognosis of PLA.
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Affiliation(s)
- Dong-Gyun Ko
- Department of Physiology, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Ji-Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Medical Center, 22, Gwanpyeong-ro 170 Beon-gil, Anyang-si 14068, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Jung-Hee Kim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital of Hallym University Medical Center, Hwaseong-si 18450, Korea
| | - Jang-Han Jung
- Department of Internal Medicine, Dongtan Sacred Heart Hospital of Hallym University Medical Center, Hwaseong-si 18450, Korea
| | - Hyoung-Su Kim
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, 18, Cheonho-daero 173-gil, Seoul 05355, Korea
| | - Ki-Tae Suk
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital of Hallym University Medical Center, 77, Chuncheon-si 24253, Korea
| | - Myoung-Kuk Jang
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, 18, Cheonho-daero 173-gil, Seoul 05355, Korea
| | - Sang-Hoon Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital of Hallym University Medical Center, 1, Singil-ro, Seoul 07441, Korea
| | - Myung-Seok Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital of Hallym University Medical Center, 1, Singil-ro, Seoul 07441, Korea
| | - Dong-Joon Kim
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital of Hallym University Medical Center, 77, Chuncheon-si 24253, Korea
| | - Sung-Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Medical Center, 22, Gwanpyeong-ro 170 Beon-gil, Anyang-si 14068, Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Correspondence: ; Tel.: +82-31-380-3708
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17
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Chan KS, Junnarkar SP, Low JK, Huey CWT, Shelat VG. Aging is Associated with Prolonged Hospitalisation Stay in Pyogenic Liver Abscess-A 1:1 Propensity Score Matched Study in Elderly Versus Non-Elderly Patients. Malays J Med Sci 2022; 29:59-73. [PMID: 36474543 PMCID: PMC9680999 DOI: 10.21315/mjms2022.29.5.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mortality of pyogenic liver abscess (PLA) is high ranging 10%-40%. Old age predicts outcomes in many diseases but there is paucity of data on PLA outcomes. We aim to compare the morbidity and mortality between elderly and non-elderly in PLA. METHODS This is a retrospective study from 2007-2011 comparing elderly (≥ 65 years old) and non-elderly (< 65 years old) with PLA. A 1:1 propensity score matching (PSM) was performed. Baseline clinical profile and outcomes were compared. RESULTS There were 213 patients (elderly patients = 90 [42.3%], non-elderly patients = 123 [57.7%]). Overall median age is 62 (interquartile range [IQR] = 53-74) years old. PSM resulted in 102 patients (51 per arm). Length of hospitalisation stay (LOS) was significantly longer in elderly patients in both unmatched (16 [IQR = 10-24.5] versus 11 [IQR = 8-19] days; P < 0.001) and matched cohorts (17 [IQR = 13-27] versus 11 [IQR = 7-19] days; P = 0.001). In-hospital mortality was significantly higher in elderly patients in the unmatched cohort (elderly patients = 21.1%, non-elderly patients = 7.3%; P = 0.003) but was insignificant following PSM (elderly patients = 15.7%, non-elderly patients = 9.8%; P = 0.219). Duration of antibiotic therapy and need for percutaneous drainage (PD) were comparable before and after PSM. CONCLUSION Age ≥ 65 years old is associated with longer LOS. In-hospital mortality though higher in elderly patients, was not statistically significant.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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18
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Chen H, Fang L, Chen W, Yang Q, Li D, Hu D, Zhang J. Pyogenic liver abscess-caused Klebsiella pneumoniae in a tertiary hospital in China in 2017: implication of hypervirulent carbapenem-resistant strains. BMC Infect Dis 2022; 22:685. [PMID: 35945499 PMCID: PMC9361654 DOI: 10.1186/s12879-022-07648-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the epidemiology of Klebsiella pneumoniae (K. pneumoniae) inducing pyogenic liver abscess (PLA) in east China and the role of hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP). Methods Forty-three K. pneumoniae strains were collected from 43 patients with PLA at Hangzhou, China in 2017. Antimicrobial susceptibility tests, string test, multilocus sequence typing, pulsed-field gel electrophoresis, mobile genetic elements typing, regular PCR and sequencing, and Galleria mellonella (G. mellonella) lethality test were used to elucidate the epidemiology. Clinical data were collected. Results K. pneumoniae strains with serotypes K1 and K2 accounted for 69.8%, which shared 46.5% and 23.3% respectively. K. pneumoniae strains with clonal group 23 were predominant with a rate of 34.9%. Such antimicrobials showed susceptible rates over 80.0%: cefuroxime, cefotaxime, gentamycin, ticarcillin/clavulanate, ceftazidime, cefoperazone/tazobactam, cefepime, aztreonam, imipenem, meropenem, amikacin, tobramycin, ciprofloxacin, levofloxacin, doxycycline, minocycline, tigecycline, chloramphenicol, and trimethoprim-sulfamethoxazole. PFGE dendrogram showed 29 clusters for the 43 K. pneumoniae strains. Three Hv-CRKP strains were confirmed by G. mellonella lethality test, showing a constituent ratio of 7.0% (3/43). Totally three deaths were found, presenting a rate of 7.0% (3/43). The three died patients were all infected with Hv-CRKP. Conclusions K1 and K2 are the leading serotypes of K. pneumoniae causing PLA, which show highly divergent genetic backgrounds. Aminoglycosides, Generation 2nd to 4th cephalosporins, β-lactamase/β-lactamase inhibitors, carbapenems, fluoroquinolones are empirical choices. Hv-CRKP may confer an urgent challenge in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07648-0.
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Affiliation(s)
- Hongchao Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Lanfang Fang
- Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Wenjie Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Qing Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China
| | - Dan Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Dakang Hu
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, 318000, China.
| | - Jin Zhang
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, 318000, China.
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Clinical Characteristics of Diabetes Complicated by Bacterial Liver Abscess and Nondiabetes-Associated Liver Abscess. DISEASE MARKERS 2022; 2022:7512736. [PMID: 35521637 PMCID: PMC9064492 DOI: 10.1155/2022/7512736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
Background. Bacterial liver abscess (BLA) is a secondary infectious disease caused by hepatic parenchymal inflammation and bacterial necrosis. Studies have shown that diabetic patients with BLA have higher rates of related adverse events than patients without diabetes. Aim. To explore the clinical characteristics of BLA complicated with diabetes and nondiabetes-related BLA. Methods. From January 2019 to June 2020, 61 diabetic patients with BLA were included as the study group, and 61 BLA patients without diabetes were included as the control group. Clinical manifestations, laboratory examination index (prothrombin activity (PTA), albumin (propagated), white blood cell count (WBC), red blood cell count (RBC), plasma fibrinogen (FIB), C-reactive protein (CRP), neutrophil percentage (NEUT), and prealbumin (PA)) levels, blood cultivation, and fester situation in the two groups were analyzed. Results. No differences of Fever, right upper abdominal pain, jaundice, vomiting and nausea, liver tenderness, and liver pain upon percussion were observed between the study and control groups. However, chill, cough and expectoration, and liver pain upon percussion were higher in the study group, while abdominal distension was lower. WBC, RBC, PA, PTA, FIB, and CRP were higher than the control group. NEUT was higher in the study group than in the control group and Alb was lower than that in the control group. There was no significant difference between the positivity of blood bacterial culture in the study and control groups. The positivity rate of Klebsiella pneumoniae in Gram-negative aerobic bacteria in the study group was higher than that in the control group. There was no significant difference between the positivity of fester culture of the two groups. The positivity of K. pneumoniae in Gram-negative aerobic bacteria in the study group was higher than that in the control group. The positivity of E. coli was lower in the study group than in the control group. Conclusion. Clinical manifestations and laboratory results of BLA patients with and without diabetes mellitus were significantly different. The symptoms of diabetics with BLA were serious.
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20
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Liu Y, Guo W, Gao S, Luo M, Liang K. A Case of Hepatic Tuberculosis with Acquired Immune Deficiency Syndrome. Am J Med Sci 2022; 363:552-555. [PMID: 35296407 DOI: 10.1016/j.amjms.2021.10.032] [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: 09/02/2020] [Revised: 06/03/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
Hepatic tuberculosis (TB) is a rare type of extrapulmonary TB. Due to the nonspecific clinical symptoms and imaging manifestations, hepatic TB with human immunodeficiency virus (HIV) infection is easy to be misdiagnosed. We report a case of hepatic TB with acquired immune deficiency syndrome (AIDS), which was initially misdiagnosed as general bacterial liver abscess even after the patient received needle biopsy. In subsequent process, pathogenic tests using washing solution of punctured liver tissue sample were proved feasible, convenient, and specific for pathogenic diagnosis in resource-limited areas of China. For liver abscess in patients with HIV, the pathogens are more complex than HIV negative patients. Some uncommon pathogens, such as TB and fungi, should also be taken into consideration. For the hepatic TB without abscess formation, pathogenic test using washing solution of punctured liver tissue sample should be attached importance.
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Affiliation(s)
- Yanbin Liu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan University, Hubei, China
| | - Wei Guo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China; Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Shicheng Gao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan University, Hubei, China
| | - Mingqi Luo
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan University, Hubei, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan University, Hubei, China; Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan University, Hubei, China; Center of Preventing Mother-to-child transmission for Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China; Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China.
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21
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[Bacterial hepatobiliary infections : Pathogen spectrum, antimicrobial resistance and current treatment concepts]. Internist (Berl) 2022; 63:349-366. [PMID: 35238985 DOI: 10.1007/s00108-022-01277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/07/2022]
Abstract
Ascending cholangitis and pyogenic liver abscesses are acute febrile bacterial hepatobiliary diseases. Nowadays they frequently occur in patients with structural changes of the biliary system and are usually treated by a combination of interventional drainage procedures and antimicrobial therapy. While Gram-negative Enterobacterales were identified as major causes in the past, biliary tract interventions and antibiotic exposure have contributed to an increase in enterococcal species and extended spectrum beta-lactamase (ESBL)-producing Enterobacterales. When selecting an appropriate empirical treatment the treating internist must consider local and individual risk factors for antimicrobial resistance in addition to pharmacokinetic aspects and disease severity to reduce the likelihood of treatment failure.
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22
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Maliyakkal AM, Naushad VA, Al Mokdad OI, Hanana F, Basheer SM, Palaki JA. Gas Under Diaphragm: A Rare Case of Ruptured Liver Abscess With Gas Forming Organism. Cureus 2022; 14:e21672. [PMID: 35242462 PMCID: PMC8884540 DOI: 10.7759/cureus.21672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/07/2022] Open
Abstract
Acute abdominal pain with free air under the diaphragm visible on chest/abdomen X-ray (pneumoperitoneum) is a medical emergency. Most of such cases of pneumoperitoneum are attributable to perforated hollow viscus; however, other possibilities like rupture of liver abscess (by a gas-forming organism) also need to be considered. Further imaging like a CT scan might help in the diagnosis and would also obviate the need for laparotomy in some of such cases. We report a case of acute abdominal pain with gas under the diaphragm due to a ruptured liver abscess caused by Klebsiella pneumoniae. The patient was managed successfully with ultrasound-guided percutaneous aspiration and insertion of a drain along with antibiotics and supportive measures, and no laparotomy was performed.
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23
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Liu Y, Zhu H, Yin Y, Yan Z. Left eye enucleation caused by multi-systemic Klebsiella pneumoniae invasive syndrome. J Int Med Res 2022; 50:3000605211069284. [PMID: 34994239 PMCID: PMC8743943 DOI: 10.1177/03000605211069284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Klebsiella pneumoniae is generally considered the most common pathogenic bacterium causing community-acquired pneumonia. In recent years, cases of liver abscess caused by the bacterium and its spread have been reported in Asia and other parts of the world. This clinical symptom of liver abscess caused by hypervirulent K. pneumoniae and its migrating infection is also called invasive K. pneumoniae liver abscess syndrome (IKPLAS). This study explored the clinical characteristics, diagnosis, and treatment of an elderly patient with IKPLAS who experienced multi-organ failure caused by the infection. The treatment of the patient was difficult, and despite our efforts, the invasive infection led to eye enucleation. This paper is expected to improve our understanding and awareness of this disease in the clinic.
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Affiliation(s)
- Yanquan Liu
- Clinical Medicine Research Center, Department of Intensive Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hongquan Zhu
- Clinical Medicine Research Center, Department of Intensive Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yue Yin
- Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Zhimin Yan
- Clinical Medicine Research Center, Department of Intensive Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
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Yu J, Ma J, Wang H, Shi Y, He S, Chen Y, Tang C. Clinical comparison of febrile and afebrile patients with pyogenic liver abscess: A two-centre retrospective study. Saudi J Gastroenterol 2021; 27:370-375. [PMID: 34657029 PMCID: PMC8656327 DOI: 10.4103/sjg.sjg_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND : Limited research has been conducted on afebrile pyogenic liver abscess (PLA). This poses a challenge in rapid diagnosis and early tailored care to physicians. In his study, we aimed to compare the clinical characteristics of afebrile and febrile patients with PLA. METHODS : We retrospectively analyzed the data of patients with PLA who were admitted to the emergency departments of two university hospitals between January 2014 and March 2020. Patients were classified into afebrile and febrile groups by using body temperature higher than 38°C as the reference standard. The demographic, clinical, and laboratory characteristics of both groups were compared. The primary outcome was all-cause in-hospital mortality and length of hospital stay. Multivariate analysis was performed to define factors associated with afebrile PLA. RESULTS : Of the 239 patients included in this study, 51 patients (21.3%) were afebrile and 188 patients (78.7%) were febrile. There were no differences between the abscess characteristics, laboratory manifestations, and disease severity of both groups; however, age and Charlson score differed between the groups (P = 0.009 and P = 0.011). The all-cause in-hospital mortality rate was much higher in the afebrile PLA group than in the febrile PLA group (9.8% vs. 2.1%, P = 0.011). Regarding the length of stay, no significant differences were noted in the febrile PLA group compared with the afebrile PLA group (18.5% vs 17.3%, P = 0.514). In multivariate analyses, only age greater than 65 years was significantly associated with afebrile PLA. CONCLUSIONS : Afebrile patients with PLA tend to be older, have higher Charlson scores, and in-hospital mortality rate than those with febrile patients. PLA patients older than 65 years are more likely to present without fever (<38°C) at the time of the emergency visit.
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Affiliation(s)
- Jie Yu
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Jun Ma
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Hairong Wang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Xinhua Hospital, Kongjiang Road, Yangpu District, Shanghai, China
| | - Yujun Shi
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Shuangjun He
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Yi Chen
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China
| | - Chao Tang
- Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, Jiangyue Road, Minhang District, Shanghai, China,Address for correspondence: Dr. Chao Tang, Department of Emergency, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital, 2000 Jiangyue Road, Minhang District, Shanghai - 200025, China. E-mail:
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25
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Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin. IDCases 2021; 26:e01276. [PMID: 34522614 PMCID: PMC8426520 DOI: 10.1016/j.idcr.2021.e01276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKP) with a high mucus phenotype, can cause liver abscess and extrahepatic invasive infection. The morbidity of hvKP infections has increased recently. Here we describe a case report of septicemia caused by hvKP due to the term septic arthritis of right knee joint in a 29-year-old male. The patient was persistent fever with a peak temperature at 40.6 °C. However, based on the drug sensitivity, the treatment failed frequently. The patient did not improve clinically on susceptible monotherapy antimicrobial. Combination therapy with meropenem and rifampicin (RFP) lead to clinical improvement and discharge.
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Key Words
- BSIs, bloodstream infections
- Bacteremia
- CK, creatine kinase
- CK-MB, MB isoenzyme of creatine kinase
- Carbapenems
- GLU, glucose in the blood
- Hs-CRP, hypersensitive C-reactive protein
- Hypervirulent Klebsiella pneumoniae
- KPLA, Klebsiella pneumoniae liver abscess
- Liver abscess
- RFP, Rifampicin
- Rifampicin
- hvKP, hypervirulent Klebsiella pneumoniae
- magA, mucus related gene A
- rmpA, regulator of mucoid phenotype A
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Qi M, He L, Zheng P, Shi X. Clinical Features and Mortality of Endogenous Panophthalmitis in China: A Six-Year Study. Semin Ophthalmol 2021; 37:208-214. [PMID: 34280072 DOI: 10.1080/08820538.2021.1954205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the clinical features, treatment strategy, and mortality of patients with endogenous panophthalmitis (EP). METHODS Fifteen patients (16 eyes) diagnosed with EP from December 2012 to December 2018 were investigated with a standard protocol at a tertiary medical center of the largest eye center in Northern China. Mortality was followed up. RESULTS All participants were Han Chinese. The mean age was 58.3, 62.5% were male, and 93.3% were unilaterally involved. The average number of predisposing factors was 3.0. The top two predisposing factors were diabetes mellitus (DM, 93.3%) and pyogenic liver abscess (PLA, 66.7%). All patients initially presented at an ophthalmic emergency due to severe ocular symptoms. All patients were co-managed by relevant specialists and were admitted to medical or surgical wards instead of the eye center unless the systemic condition was well controlled. Only four eyes were eligible for vitrectomy. The mean follow-up duration was 12.5 months. The mortality rate was 0%. The predominant causative organism was Klebsiella pneumoniae (80.0%), and there were no positive fungal cases. CONCLUSIONS EP is a rare, life-threatening disease. DM and PLA could predispose its development. The predominant causative organism was Klebsiella pneumoniae. The interdisciplinary cooperation system of the management of EP may reduce the mortality rate.Abbreviations :EP: endogenous panophthalmitis; EE: endogenous endophthalmitis; DM: diabetes mellitus; PLA: pyogenic liver abscess; ACI: acute cerebral infarction; UTI: urinary tract infection; ICU: intensive care unit; VA: visual acuity; LP: light perception; HM: hand motion; NLP: no light perception; K. pneumoniae: Klebsiella pneumoniae; CT: computed tomography; MRI: magnetic resonance imaging; CRP: C-reactive protein; PCT: procalcitonin; FBG: fasting blood glucose; WBC: white blood cell; NEUT: neutrophil proportion; BDG: 1,3-β-D-glucan; GM: galactomannan; IVI: intravitreal injection; PPV: pars plana vitrectomy; ILAS: invasive liver abscess syndrome; cps: capsular polysaccharide; CSF: cerebrospinal fluid; SD: standard deviation.
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Affiliation(s)
- Meng Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Lei He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Pengfei Zheng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Xiangyu Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
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Song H, Wang X, Lian Y, Wan T. Analysis of the clinical characteristics of 202 patients with liver abscess associated with diabetes mellitus and biliary tract disease. J Int Med Res 2021; 48:300060520949404. [PMID: 32865074 PMCID: PMC7469731 DOI: 10.1177/0300060520949404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Clinical characteristics of patients with pyogenic liver abscess (PLA) of varying etiologies may be different. This study aimed to analyze the clinical characteristics, pathogenic bacteria, treatment, and prognosis of patients with PLA associated with diabetes and biliary disease. METHODS Clinical, imaging, and laboratory data from 202 inpatients with PLA were retrospectively analyzed. RESULTS Eighty-eight patients (43.6%) had a history of diabetes, 73 (36.1%) had a history of underlying biliary tract disease, and 24 (11.9%) had both the diseases. The level of C-reactive protein (CRP) increased in 99.2% (119/120) patients, and the level of procalcitonin (PCT) increased in 95.5% (148/155) patients. The main pathogen of PLA was Klebsiella pneumoniae. The incidence of bloodstream infection increased by 34.4% (22/64) in patients with PLA that was associated with diabetes mellitus, and that of K. pneumoniae infection was 88.6% (39/44). The readmission rate for patients with PLA with underlying biliary diseases was 10.2 to 12.5%. CONCLUSION The main pathogen of PLA is K. pneumoniae, which is sensitive to most antibiotics. Patients with PLA associated with diabetes were more likely to have bloodstream infections, and the recurrence rate of PLA with underlying biliary diseases was higher than without biliary duct disease.
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Affiliation(s)
- Huiwen Song
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Xianbin Wang
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Yubao Lian
- Department of Infectious Diseases, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
| | - Tuer Wan
- Department of Imaging Medicine, Saming First Hospital Affiliated with Fujian Medical University, Fujian Province, China
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Tai CH, Hsu CN, Yang SC, Wu CK, Liang CM, Tai WC, Chuah SK, Lee CH. The impact of aspirin on Klebsiella pneumoniae liver abscess in diabetic patients. Sci Rep 2020; 10:21329. [PMID: 33288865 PMCID: PMC7721809 DOI: 10.1038/s41598-020-78442-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
In this study, we aimed to investigate the impact of aspirin on the risk of pyogenic liver abscess caused by Klebsiella pneumoniae (KP-PLA) and invasive KP-PLA syndrome (IKPS) in diabetic patients. Diabetic patients who were propensity-score matched were retrospectively included from hospital-based database. Kaplan-Meier approach with a log-rank test was used to compare the cumulative incidences of KP-PLA including IKPS between aspirin users and non-users. Totally, 63,500 patients were analyzed after propensity-score matching (1:1). Compared with that of non-users, the incidence of KP-PLA was significantly reduced in aspirin users (0.31% vs. 0.50%, p < 0.01), but not for that of IKPS (0.02% vs. 0.03%, p = 0.29). Patients taking aspirin for ≥ 90 days had a significantly lower risk for KP-PLA (hazard ratio, 0.67; 95%CI, 0.50-0.90). Females, taking clopidogrel or metformin for ≥ 90 days, and taking H2-blockers or proton pump inhibitors (PPIs) for ≥ 5 days were also associated with a lower risk of KP-PLA. However, cholangitis and a glycated hemoglobin ≥ 8.5% were associated with an increased risk of KP-PLA.
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Affiliation(s)
- Chien-Hsiang Tai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. .,College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
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Chan KS, Thng CB, Chan YH, Shelat VG. Outcomes of Gas-Forming Pyogenic Liver Abscess Are Comparable to Non-Gas-Forming Pyogenic Liver Abscess in the Era of Multi-Modal Care: A Propensity Score Matched Study. Surg Infect (Larchmt) 2020; 21:884-890. [PMID: 32216699 DOI: 10.1089/sur.2019.278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Gas-forming pyogenic liver abscess (GFPLA) occurs in 7%-24% of all PLAs and has been associated traditionally with high mortality rates. Studies have suggested that the use of a proactive approach of prompt resuscitation, parenteral antibiotic agents, percutaneous drainage, and a dedicated multi-disciplinary team may improve clinical outcomes. Hence, we aim to investigate whether the clinical outcomes of PLA are determined by gas formation. Methods: This is a retrospective study of patients with PLA from 2007 to 2011. A 1:2 propensity score matching (PSM) analysis was performed using age, co-morbid diabetes mellitus, presence of septic shock, hemoglobin levels, international normalized ratio, creatinine, total bilirubin, positive blood culture and pus culture, and the size of abscess. Baseline demographics, clinical profile, and peri-operative data were compared. Results: There were 213 patients who had PLA: 41 (19.2%) patients had GFPLA and 172 (80.8%) patients had non-GFPLA. The PSM analysis resulted in a total of 108 patients (36 GFPLA and 72 non-GFPLA). Median duration of parenteral antibiotic agents was significantly lower in the GFPLA group (9.5 d vs. 14 d, p = 0.044), but median total duration of antibiotic use was comparable (GFPLA 39 d vs. non-GFPLA 37 d, p = 0.634). Median length of stay (days) did not differ significantly between GFPLA and non-GFPLA (14 vs. 15, p = 0.299). There were no statistically significant differences between GFLPA and non-GFLPA in the need for percutaneous drainage (26/36 (72.2%) vs. 47/72 (65.3%), respectively, p = 0.467) and in-hospital all-cause death (4/36 (11.1%) vs. 7 (9.7%), p = 0.822) Conclusions: Outcomes of GFPLA are comparable to those of non-GFPLA in the era of multi-modal care.
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Affiliation(s)
- Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Yiong-Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Zhang J, Gao Y, Du Z, Ren Y, Bi J, Wu Z, Lv Y, Wu R. Clinical Features and Prognosis of Gas-Forming and Non-Gas-Forming Pyogenic Liver Abscess: A Comparative Study. Surg Infect (Larchmt) 2020; 22:427-433. [PMID: 32857017 DOI: 10.1089/sur.2020.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Gas-forming pyogenic liver abscess (GFPLA) accounts for up to 30% of all pyogenic liver abscess (PLA) cases. However, little is known of the differences in clinical features and prognosis between GFPLA and non-GFPLA. Aim: This retrospective study compared the clinical features and prognosis of GFPLA and non-GFPLA. Patients and Methods: Data for 392 patients with PLA treated from January 1, 2007 to December 31, 2016 were reviewed. Gas-forming pyogenic liver abscess was defined as gas in the abscess. Liver abscesses were considered non-GFPLA (n = 326) or GFPLA (n = 66). The clinical features and outcomes of patients with GFPLA were compared with that of patients without GFPLA. Results: The groups were similar in gender ratio, age, smoking, drinking, and comorbidities. Klebsiella pneumoniae was the most common pathogenic bacteria, but the negative rate of bacterial culture of the non-GFPLA group was higher than that of the GFPLA. In etiologies, the GFPLA group had more biliary source infection and less cryptogenic infection. In addition, the GFPLA group had a higher rate of previous hepatobiliary surgery, especially biliary enteric anastomosis. Compared with the non-GFPLA group, the percentage of the GFPLA group with antibiotic agents combined with percutaneous drainage was higher, whereas the percentages given antibiotic agents alone and antibiotic agents combined with surgical drainage were lower. Patients with GFPLA had higher rates of sepsis and pleural effusion, and longer hospital stays than did non-GFPLA patients. No patient died during hospitalization. Conclusions: The GFPLA group had more biliary source infection and less cryptogenic infection in etiologies. Gas-forming pyogenic liver abscess is associated with past hepatobiliary surgery, especially biliary enteric anastomosis and has high rates of sepsis and long hospitalization. Thus, the patients with PLA with a history of hepatobiliary surgery should be monitored more closely in the early stage of the PLA. It needs to be recognized as a distinct clinical entity.
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Affiliation(s)
- Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Gao
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Gastrointestinal Surgery Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Zhaoqing Du
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yifan Ren
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jianbin Bi
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Trillos-Almanza MC, Restrepo Gutierrez JC. How to manage: liver abscess. Frontline Gastroenterol 2020; 12:225-231. [PMID: 33912334 PMCID: PMC8040501 DOI: 10.1136/flgastro-2019-101240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/28/2019] [Accepted: 12/24/2019] [Indexed: 02/04/2023] Open
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32
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Yi H, Huang J, Guo L, Zhang Q, Qu J, Zhou M. Increased Antimicrobial Resistance among Sputum Pathogens from Patients with Hyperglycemia. Infect Drug Resist 2020; 13:1723-1733. [PMID: 32606822 PMCID: PMC7295332 DOI: 10.2147/idr.s243732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background Glucose management is of great significance. Infection and hyperglycemia are a vicious circle. This study was conducted to describe distribution and antimicrobial resistance of bacteria isolated from patients with normoglycemia, hyperglycemia, or diabetes on admission. Methods A retrospective study was conducted in a teaching hospital from January 2015 to March 2017. Bacteria were identified by the Vitek 2 automated system and antimicrobial susceptibility determined. Results A total of 1,163 patients were included: 582 with normoglycemia, 292 with hyperglycemia and 289 with diabetes. Enterobacter, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterococcus faecium were the main species isolated from these patients, with 1,616 unduplicated isolates from sputum samples. Patients with hyperglycemia were more prone to carry more than one species, and the rate of multidrug-resistant K. pneumoniae and methicillin-resistant S. aureus was higher in this group. K. pneumoniae from hyperglycemia patients demonstrated increased resistance to carbapenems, especially imipenem (p=0.002) and meropenem (p=0.003), than those isolated from patients with normoglycemia or diabetes. No significance was detected for K. pneumoniae, A. baumannii, or P. aeruginosa between nondiabetes and diabetes patients. In addition, hyperglycemia patients had a higher rate of ICU admission (p=0.035) and a lower survival rate (p<0.001). Conclusion Patients with hyperglycemia were more prone to carry bacteria, especially multidrug-resistant K. pneumoniae and methicillin-resistant S. aureus. Assessing glucose on admission is of great significance in predicting bacterial carriage and antimicrobial resistance.
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Affiliation(s)
- Huahua Yi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jingwen Huang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Lingxi Guo
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qiurui Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jieming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Abstract
Pyogenic liver abscesses are classified by the bacteria that have caused the abscess because this guides treatment and can point to the underlying cause. The most common cause is biliary disease. The diagnosis is made by imaging. Treatment is a combination of antibiotics and percutaneous drainage. Amebic liver abscess is caused by extraintestinal spread of Entamoeba histolytica. E histolytica is spread by fecal-oral transmission and typically colonizes the gastrointestinal tract. It is diagnosed based on imaging and the mainstay of treatment is metronidazole. Only about 15% of cases require percutaneous drainage. The prognosis is good, with almost universal recovery.
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Du Z, Zhou X, Zhao J, Bi J, Ren Y, Zhang J, Lin Y, Wu Z, Lv Y, Zhang X, Wu R. Effect of diabetes mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization. BMC Infect Dis 2020; 20:145. [PMID: 32066406 PMCID: PMC7027105 DOI: 10.1186/s12879-020-4855-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is an inflammatory disease with increasing incidence. When it occurs with diabetes mellitus (DM), the risk of recurrence and mortality may increase. However, the effect of DM on the short-term prognosis of PLA patients after hospitalization remained unknown. METHODS Two hundred twenty-seven PLA patients who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to January 2018 were retrospectively enrolled. They were divided into two groups as the DM group (n = 61) and the Non-DM group (n = 166). In the DM group, HbA1C level < 7% was considered to be good-control of glycaemia (n = 23). The clinical characteristics and overall short-term survival were analyzed. RESULTS The proportion of PLA patients with DM was 26.87%. In the DM group, there was a higher incidence of hypertension and Candida spp. infection. Conservative administration and percutaneous drainage were mainly used in patients with good- (60.87%) and poor-control (60.53%) of glycaemia, respectively. During follow-up, 24 (10.57%) died due to uncontrolled systemic infections and other serious complications. Compared with PLA patients without DM, patients in the DM group had significantly increased 6-month mortality rate after discharge (Log-Rank test, P = 0.021). Poor-control of glycaemia did not reduce the six-month survival, while the recurrence rate of PLA within 3 months showed an almost 3-fold increase (13.16% vs. 4.35%). Further multivariate analyses found that DM was the only independent risk factor for the PLA six-month survival (odds ratio [OR]: 3.019, 95% confidence interval [CI]: 1.138-8.010, P = 0.026). However, the blood glucose level had no significant effect on the short-term survival of PLA patients with DM (Log-Rank test, P = 0.218). CONCLUSIONS In PLA patients, DM aggravated short-term mortality and blood glucose levels should be well controlled.
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Affiliation(s)
- Zhaoqing Du
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Xingchen Zhou
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Junzhou Zhao
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jianbin Bi
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yifan Ren
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jia Zhang
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yuxin Lin
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yi Lv
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Xufeng Zhang
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China. .,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
| | - Rongqian Wu
- National-Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
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Kim EJ, Ha KH, Kim DJ, Choi YH. Diabetes and the Risk of Infection: A National Cohort Study. Diabetes Metab J 2019; 43:804-814. [PMID: 31701687 PMCID: PMC6943267 DOI: 10.4093/dmj.2019.0071] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/15/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Several studies have shown that people with diabetes are vulnerable to infection. This study compared the risk of infection-related hospitalizations, intensive care unit (ICU) admission, and deaths between the person with diabetes and the general population in South Korea. METHODS We conducted a cohort study of 66,426 diabetes and 132,852 age-sex-region-matched non-diabetes controls from the general population using a sample of data from the National Health Insurance Service-National Sample Cohort. The cohort was followed up for 9 years. Infections were classified into 17 separate categories. We used Poisson regression, with adjustment for household income and other comorbidities, to estimate incidence rate ratios (IRRs) in order to compare of infection-related hospitalizations, ICU admissions, and deaths. RESULTS Compared to non-diabetes controls, diabetes group had a greater risk of almost all the types of infections considered, with the adjusted IRRs (aIRRs) for infection-related hospitalizations being the highest for hepatic abscess (aIRR, 10.17; 95% confidence interval [CI], 7.04 to 14.67), central nervous system (CNS) infections (aIRR, 8.72; 95% CI, 6.64 to 11.45), and skin and soft tissue infections other than cellulitis (SSTIs) (aIRR, 3.52; 95% CI, 3.20 to 3.88). Diabetes group also had a greater risk of ICU admission and death due to SSTIs (aIRR, 11.75; 95% CI, 7.32 to 18.86), CNS infections (aIRR, 5.25; 95% CI, 3.53 to 7.79), and bone and joint infections (aIRR, 4.78; 95% CI, 3.09 to 7.39). CONCLUSION In South Korea, people with diabetes has a considerably higher incidence of infection-related hospitalizations and deaths than the general population.
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Affiliation(s)
- Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea.
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Erem AS, Krapivina A, Braverman TS, Allamaneni SS. Serratia Liver Abscess Infection and Cardiomyopathy in a Patient with Diabetes Mellitus: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1343-1349. [PMID: 31506419 PMCID: PMC6753664 DOI: 10.12659/ajcr.918152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Female, 45 Final Diagnosis: Serrata liver abscess with diabetes mellitus and cardiomyopathy Symptoms: Anxiety • generalized weakness Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Anna Sarah Erem
- Saba University School of Medicine, The Bottom, Saba, Dutch Caribbean, Netherlands
| | - Anna Krapivina
- Department of Surgery, The Jewish Hospital - Mercy Health, Cincinnati, OH, USA
| | - Timothy S Braverman
- Department of Pathology, The Jewish Hospital - Mercy Health, Cincinnati, OH, USA
| | - Shyam S Allamaneni
- Department of Surgery, The Jewish Hospital - Mercy Health, Cincinnati, OH, USA
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Shiryajev YN, Ryllo AG, Grechukhin SN, Karpenko MO, Busheva AI, Koronnova EN, Glebova AV, Kokhanenko NY. Ruptured Pyogenic Liver Abscess with Pneumoperitoneum 19 Years After Pancreatoduodenectomy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1039-1045. [PMID: 31316049 PMCID: PMC6659458 DOI: 10.12659/ajcr.916755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rupture of a pyogenic liver abscess is rare but serious complication. In patients after pancreatoduodenectomy, there are some conditions causing the development of liver abscesses (e.g., chronic reflux-cholangitis, efferent jejunal loop stasis, stenosis of the biliary anastomosis, and pancreatogenic diabetes). However, the number of published cases of liver abscess after pancreatoduodenectomy is small. CASE REPORT A 42-year-old male was admitted with severe abdominal pain, fever, and jaundice. Nineteen years previously, he had undergone pancreatoduodenectomy and cholecystectomy for chronic pancreatitis with obstructive jaundice. Two years later, diabetes mellitus was diagnosed, with subsequent insulin treatment. At admission, symptoms of peritonitis were present. Plain abdominal radiography showed free gas under the right hemidiaphragm and heterogeneous liver shade with small gas-fluid levels. The rupture of a liver abscess was suspected. Laparotomy with adhesiolysis, debridement of the liver abscess cavity, and abdominal drainage were performed. The postoperative period was complicated by sepsis, right lower lobe pneumonia, and two-sided pleural effusions, on the background of insulin-dependent diabetes and malnutrition. The patient was discharged on the 40th day and the subdiaphragmatic drains were removed on the 114th day. Sixteen months after surgery, the patient's condition was satisfactory. Magnetic resonance imaging and echography showed the absence of biliary hypertension. The liver tissue had healed completely. CONCLUSIONS A unique case of ruptured liver abscess after pancreatoduodenectomy is presented. To the best of our knowledge, this is the first published case with such a long time interval (19 years) between pancreatoduodenectomy and the formation of a pyogenic liver abscess.
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Affiliation(s)
- Yuri N Shiryajev
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Andrey G Ryllo
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Sergey N Grechukhin
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Maria O Karpenko
- Department of Hospital Surgery #2, I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Anna I Busheva
- Department of Hospital Surgery #2, I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Elena N Koronnova
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Anna V Glebova
- Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation.,Sixth Department of Surgery, Mariinsky Hospital, Saint Petersburg, Russian Federation
| | - Nikolay Y Kokhanenko
- Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation
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Ruiz-Hernández JJ, Conde-Martel A, Serrano-Fuentes M, Hernández-Meneses M, Merlán-Hermida A, Rodríguez-Pérez A, Marchena-Gómez J. Pyogenic liver abscesses due to Escherichia coli are still related to worse outcomes. Ir J Med Sci 2019; 189:155-161. [PMID: 31144263 DOI: 10.1007/s11845-019-02041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In western countries, there has been a gradual shift from Escherichia coli to Klebsiella pneumoniae as an emerging pathogen isolated from pyogenic liver abscesses (PLA). AIMS To compare outcomes between patients with Escherichia coli liver abscesses and non-Escherichia coli liver abscesses in terms of mortality. METHODS One hundred nine-three consecutive hospital admissions of Pyogenic liver abscesses were analyzed, mean age 66.9 years old (± 13.6), 112 men (58%). The sample was divided into two groups: E. coli liver abscesses and non-E. coli liver abscesses. The etiologic, clinical, and microbiologic characteristics; therapeutic options; and outcomes, in terms of morbidity and mortality, between E. coli and non-E. coli liver abscesses were compared. In-hospital mortality, as outcome variable, was analyzed in a multivariate analysis. RESULTS Fifty-seven episodes of PLA (29.5%) corresponded to E. coli infections, and 136 (70.5%) to non-E. coli infections. Patients with E. coli PLA were more likely to have jaundice, polymicrobial isolation (57.1% vs 21.6%, p < 0.001), biliary origin (71.9% vs 39%, p < 0.001), and septic shock (38.6% vs 12.5%, p < 0.001). Antibiotic therapy alone, without percutaneous drainage, was less common in the E. coli PLA group (5.3% vs 18.4%, p = 0.018). These patients also showed a higher mortality (28.1% vs 11%, p = 0.003). In multivariate analysis, E. coli isolation PLA adjusted remained as an independent factor of mortality (OR 2.6, 95%CI 1.04-6.56, p = 0.041). CONCLUSIONS E. coli liver abscess may preclude a worse outcome than other microbiological agents, including the development of septic shock and mortality. Aggressive management must be considered.
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Affiliation(s)
- Jose Juan Ruiz-Hernández
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain.,Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Alicia Conde-Martel
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain. .,Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Miriam Serrano-Fuentes
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain
| | - Marta Hernández-Meneses
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain
| | - Alejandro Merlán-Hermida
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain
| | - Alba Rodríguez-Pérez
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain
| | - Joaquín Marchena-Gómez
- Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.,Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain
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Liu B, Yi H, Fang J, Han L, Zhou M, Guo Y. Antimicrobial resistance and risk factors for mortality of pneumonia caused by Klebsiella pneumoniae among diabetics: a retrospective study conducted in Shanghai, China. Infect Drug Resist 2019; 12:1089-1098. [PMID: 31123410 PMCID: PMC6511257 DOI: 10.2147/idr.s199642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/23/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose: To investigate antimicrobial resistance and risk factors for mortality of Klebsiella pneumoniae (KP) pneumonia in diabetics and nondiabetics. Patients and methods: A retrospective study was conducted among inpatients of KP pneumonia via electronic medical records in a territory hospital between January 2016 and June 2018. Antimicrobial resistance in KP pneumonia was compared between diabetics and nondiabetics. Independent risk factors for mortality in KP pneumonia were identified by univariate and multivariate logistic regression among diabetics and nondiabetics separately. Results: In this study, 456 patients with KP pneumonia were included. There were 156 cases with diabetes and 300 without diabetes. KP showed a lower antimicrobial resistance to a multitude of antimicrobials in pneumonia among diabetics than nondiabetics, namely aztreonam, cefotetan, sulperazone, meropenem, amikacin, tobramycin, sulfamethoxazole, and fosfomycin. In addition, carbapenem-resistant Klebsiella pneumoniae (CRKP) was more prevalent among nondiabetics than diabetics who were admitted to intensive care unit (ICU) (63.0% vs 45.1%, P = 0.038). Multivariable analysis showed that independent risk factors for in-hospital mortality (IHM) in KP pneumonia among diabetics differed from that among nondiabetics as well. Independent predictors for IHM of KP pneumonia among diabetics were male (OR: 5.89, 95% CI: 1.34-25.93, P = 0.019), albumin (ALB) < 35 g/L (OR: 7.00, 95% CI: 2.02-24.28, P = 0.002), bloodstream infection (BSI) (OR: 21.14, 95% CI: 3.18-140.72, P = 0.002), and invasive ventilation during hospitalization (OR: 8.00, 95% CI: 2.99-21.42, P < 0.001). In nondiabetics, independent predictors were higher CURB-65 score (OR: 1.92, 95% CI: 1.29-2.86, P = 0.001), CRKP (OR: 2.72, 95% CI: 1.07-6.90, P = 0.035), BSI (OR: 4.98, 95% CI: 1.34-18.50, P = 0.017), and ICU admission (OR: 4.06, 95% CI: 1.57-10.47, P = 0.004). Conclusion: In KP pneumonia, diabetics showed lower antimicrobial resistance and different independent risk factors for mortality compared with nondiabetics, in line with previous studies. Importantly, further attention should be paid on rational and effective antibiotic and supportive treatments in order to reduce mortality without aggravating antimicrobial resistance and metabolic damage among diabetics.
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Affiliation(s)
- Bing Liu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Huahua Yi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jie Fang
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lizhong Han
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yi Guo
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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40
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Ko MC, Lin WH, Martini S, Chang YH, Chiu CT, Li CY. A cohort study of age and sex specific risk of pyogenic liver abscess incidence in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2019; 98:e15366. [PMID: 31027123 PMCID: PMC6831277 DOI: 10.1097/md.0000000000015366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To investigate the age-sex-specific incidence and relative risk of pyogenic liver abscess (PLA) in patients with type 2 diabetes mellitus (T2DM), and to assess the joint effects of T2DM and other clinical risk factors for PLA on PLA incidence. We used a population-based cohort design with Taiwan's National Health Insurance claim data. Study subjects included 613,921 T2DM patients and 614,613 controls identified in 2000 and were followed to the end of 2010. Cox regression model was employed to calculate the hazard ratio (HR) and 95% confidence interval (CI) of PLA in relation to T2DM. Over an 11-year follow-up, 5336 T2DM and 1850 controls were admitted for PLA, representing a cumulative incidence of 0.87% and 0.30%, respectively. T2DM was significantly associated with increased hazard of PLA (HR, 2.88; 95% CI, 2.73-3.04). We also found that age and gender may significantly modify the relationship between T2DM and PLA, with a higher HR noted in males patients and those aged <45 years. Biliary tract diseases (HR, 8.60; 95% CI, 7.87-9.40) and liver cirrhosis (HR, 7.52; 95% CI, 6.58-8.59) may add substantially additional risk to the incidence of PLA in T2DM patients. The increased risk of PLA in T2DM was greater in male and younger patients. Careful management of biliary tract diseases and liver cirrhosis may also help reduce the incidence of PLA in T2DM patients.
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Affiliation(s)
- Ming-Chung Ko
- Department of Urology, Taipei City Hospital
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Chang-Ta Chiu
- Department of Dentistry, An Nan Hospital, China Medical University, Tainan
| | - Chung-Yi Li
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Department of Public Health, College of Medicine, National Cheng Kung University
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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Li W, Chen H, Wu S, Peng J. A comparison of pyogenic liver abscess in patients with or without diabetes: a retrospective study of 246 cases. BMC Gastroenterol 2018; 18:144. [PMID: 30285638 PMCID: PMC6167886 DOI: 10.1186/s12876-018-0875-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022] Open
Abstract
Background Pyogenic liver abscess(PLA) has become common in patients with diabetes mellitus (DM), but it is unclear whether differences exist between patients with and without DM. A retrospective study was performed to identify these differences, summarize the clinical experience, and improve the diagnosis and treatment of PLA. Methods The patients were enrolled in a teaching hospital from January 2012 to December 2016. The patients were separated into two groups based on comorbidity with diabetes mellitus (DM). The DM group was further separated into two subgroups according to the HbA1C concentration to investigate whether glycaemic control affected the clinical characteristics of PLA patients with DM. Chi-square, Fisher’s exact test, and t-tests were used to analyse and evaluate differences between the two groups. Results Two hundred and forty-six PLA patients were identified and 90 (36.6%) had comorbid DM. Patients with DM were older, had higher levels of alkaline phosphatase and γ-glutamyl transferase, hypertension, a loss of body weight, a single abscess, and combined antibiotic therapy with the use of carbapenems and Klebsiella pneumoniae in their blood cultures but a less frequent history of abdominal surgery and Escherichia coli in their pus cultures. When DM patients were compared to non-DM patients, each of these differences was significant (P < 0.05). Diabetic PLA patients with poor glycaemic control had a significantly higher proportion of fever and both lobes abscess(P < 0.05). Conclusion PLA patients with diabetes are older, have more serious complications, a higher prevalence of cardiovascular disease, an increased use of combined antibiotic therapy with carbapenem, and K. pneumoniae as the predominant pathogen, but these patients had fewer abdominal surgeries and fewer E. coli infections. In addition, poorly controlled glycaemia in diabetic PLA patients is associated with high incidence of fever and both lobes abscess.
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Affiliation(s)
- Wenfei Li
- Department of Infectious Diseases, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Shuai Wu
- Department of Infectious Diseases, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China.
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Zhang J, Du Z, Bi J, Wu Z, Lv Y, Zhang X, Wu R. The impact of previous abdominal surgery on clinical characteristics and prognosis of pyogenic liver abscess: A 10-year retrospective study of 392 patients. Medicine (Baltimore) 2018; 97:e12290. [PMID: 30278501 PMCID: PMC6181538 DOI: 10.1097/md.0000000000012290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Many pyogenic liver abscess (PLA) patients underwent abdominal surgery before. However, little is known about the impact of previous abdominal surgery on the clinical characteristics and prognosis of PLA.The clinical data of 392 adult PLA patients who received treatment at our hospital from January 1, 2007 to December 31, 2016 were collected. The demographic data, cause, comorbidities, surgery history, clinical features, laboratory results, imaging findings, microbiological characteristics, choices of treatment, and clinical outcomes were analyzed.In all, 177 PLA patients (45.2%) underwent abdominal surgery before. The median time for the occurrence of PLA after the most recent abdominal surgery was 2.0 (interquartile range 0.25, 6.0) years. PLA patients with a previous abdominal surgery history were more likely to have underlying diseases and presented with more abnormal laboratory values. Klebsiella pneumonia and Escherichia coli were the most common pathogens. Previous abdominal surgery appeared to increase the incidence of E coli. More PLA patients without a previous abdominal surgery history required surgical drainage. However, there were no differences in PLA-related complications, days required for temperature normalization, and length of hospital stay between the 2 groups.Because a large number of PLA patients had a history of abdominal surgery, and proper screening should be performed for patients with any suspicion of a liver abscess after abdominal surgery. Despite the differences in the coexisting conditions, clinical and microbiological characteristics between PLA patients with and without a previous abdominal surgery history, the overall short-term outcomes were comparable.
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Affiliation(s)
- Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering
- Institute of Advanced Surgical Technology and Engineering
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Zhaoqing Du
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering
- Institute of Advanced Surgical Technology and Engineering
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jianbin Bi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering
- Institute of Advanced Surgical Technology and Engineering
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering
- Institute of Advanced Surgical Technology and Engineering
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xufeng Zhang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering
- Institute of Advanced Surgical Technology and Engineering
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering
- Institute of Advanced Surgical Technology and Engineering
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Chen J, Zhang M, Chen J, Ning Y, Cai X, Zhang L, Xu H, Guo J. Cryptogenic and non-cryptogenic liver abscess: A retrospective analysis of 178 cases revealed distinct characteristics. J Int Med Res 2018; 46:3824-3836. [PMID: 30091401 PMCID: PMC6136014 DOI: 10.1177/0300060518781256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To enhance theoretical support of pyogenic liver abscess (PLA) treatment by
comparing characteristics of patients with either PLA with an identified
infectious origin (non-cryptogenic) or PLA with no obvious underlying cause
(cryptogenic). Methods This retrospective study included all first episodes of PLA in adults
admitted to a tertiary hospital between 2009 and 2016. Relevant clinical
data were collected for patients with cryptogenic or non-cryptogenic PLA and
compared across a number of characteristics. Results In all, 178 patients were included: 111 cases (62.4%) of cryptogenic PLA, and
67 cases (37.6%) of non-cryptogenic PLA. Diabetes mellitus was significantly
more prevalent in patients with cryptogenic PLA than those with
non-cryptogenic PLA. The proportion of multidrug resistance/poly-microbial
infection was significantly lower and Klebsiella pneumoniae
infection was significantly higher in the cryptogenic versus non-cryptogenic
PLA group. Metastatic infection occurred in four patients with cryptogenic
PLA only, and all had diabetes and K. pneumoniae infection.
Multivariate logistic regression analysis revealed that male sex, diabetes
and K. pneumoniae were independent predictors for
cryptogenic PLA. Conclusions Cryptogenic and non-cryptogenic PLA have distinctly different
characteristics, suggesting a potential need for different treatment
approaches.
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Affiliation(s)
- Jing Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Minwei Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jinlong Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yaogui Ning
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Xiaoyang Cai
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Li Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Hao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jing Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
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Abstract
Objective An infectious hepatic cyst (IHC) is a hepatic cyst complicated with secondary infection and is generally assumed to be rare. However, we have experienced no small number of patients with IHC in recent clinical practice. We therefore examined the incidence and clinical characteristics of IHC. Methods The medical records of patients with IHC who were hospitalized at our institution between January 2012 and December 2016 were retrospectively reviewed. Their demographic factors, biochemical, bacteriological, imaging, and treatment results were explored and compared with those of patients with pyogenic liver abscess (PLA). Patients Twelve patients with IHC and 39 with PLA were identified. Results The IHCs were significantly larger in diameters than the PLAs, and patients with IHCs tended to be older and more often women than those with PLAs. IHCs showed characteristic imaging features, including heterogeneous contents with occasional fluid-debris levels, a thickened cystic wall with rim enhancement, perilesional edema and hyperaemia. Patients with IHCs had a significantly shorter hospital stay than those with PLAs. Conclusion Physicians should note that IHCs are not rare. A careful imaging evaluation can suggest an IHC, and the timely aspiration of the content can lead to an accurate diagnosis. The cystic wall may keep the infectious material confined within the IHC, resulting in the observed good treatment outcome with catheter drainage.
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Affiliation(s)
- Kazuhiko Morii
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Japan
| | - Takeharu Yamamoto
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Japan
| | | | - Hiroaki Okushin
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Japan
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Abstract
OBJECTIVES To evaluate the risk of pyogenic liver abscess (PLA) in patients receiving endoscopic sphincterotomy (ES). SETTING A population-based cohort study using data from Taiwans' National Health Insurance Research Database was conducted. Patients aged 20 or older who had undergone an ES were considered as the ES cohort. The dates for the first hospitalisation of the patients receiving ES were defined as the index dates. PARTICIPANTS Patients in the ES and non-ES cohorts were selected by 1:1 matching ratio based on a propensity score. A total of 8174 sex-matched, age-matched and index year-matched (1:1) pairs of patients receiving ES and 8174 patients without ES served as controls. Cox proportional hazards regression was employed to calculate the HRs and 95% CIs for the association between PLA and ES. RESULTS The overall incidence of PLA was significantly higher in the ES cohort than in the non-ES cohort (4.20 vs 0.94, respectively, per 1000 person-year) with the adjusted HR (aHR) 4.50 (95% CI 3.38 to 6.58) A stratified analysis during the follow-up years revealed that when the ES cohort was compared with the non-ES cohort, they displayed a higher risk of PLA during the first follow-up year (aHR 4.35, 95% CI 2.26 to 8.39) which continued significantly over the next 4-5 years of follow-up. CONCLUSIONS Patients receiving ES are associated with having a higher risk of PLA.
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Affiliation(s)
- Yen-Chun Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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46
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Kong H, Yu F, Zhang W, Li X. Clinical and microbiological characteristics of pyogenic liver abscess in a tertiary hospital in East China. Medicine (Baltimore) 2017; 96:e8050. [PMID: 28906397 PMCID: PMC5604666 DOI: 10.1097/md.0000000000008050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pyogenic liver abscess (PLA) is a potentially life-threatening disease affecting many parts of the world, especially Asia. In this study, we explored the clinical and microbiological characteristics of PLA in Chinese patients.A 5-year (2010-2014) retrospective review of medical records on all PLA patients who were admitted to a tertiary teaching hospital was performed.Among 217 PLA cases who were confirmed cultural positive, Klebsiella pneumonia (K pneumonia) was the most common pathogen (n = 165, 76.0%), followed by Escherichia coli (n = 21, 9.7%). Notably, there is a higher incidence of diabetes mellitus in patients with K pneumoniae-induced PLA (KP-PLA) than that with non-K pneumoniae-induced PLA (non-KP-PLA)(43.0% vs 21.2%, P = .005). However, it was less prevalent for concomitant hepatobiliary disease (20.0% vs 34.6%, P = .039) and history of intraabdominal trauma or surgery (13.3% vs 38.5%, P < .001) in patients with KP-PLA. Although K pneumoniae are sensitive to most common antibiotics (antibiotic resistance rates below 10%), some strains (1.2%) developed resistant to carbapenem. These results confirmed K pneumoniae as the predominant pathogen of PLA in the area in which the study was conducted. More attention should be directed toward monitoring the emergence of carbapenem-resistant K pneumoniae.KP-PLA is frequently diagnosed in patients with metabolic diseases accompanied by serious consequences, and it is therefore prudent to see that they receive sensitivity-directed antibiotic therapy.
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Affiliation(s)
- Haishen Kong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fei Yu
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Weili Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Xuefen Li
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Mücke MM, Kessel J, Mücke VT, Schwarzkopf K, Hogardt M, Stephan C, Zeuzem S, Kempf VAJ, Lange CM. The role of Enterococcus spp. and multidrug-resistant bacteria causing pyogenic liver abscesses. BMC Infect Dis 2017. [PMID: 28651522 PMCID: PMC5485679 DOI: 10.1186/s12879-017-2543-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Pyogenic liver abscesses (PLA) remain a significant clinical problem. Unfortunately, little is known about current bacterial susceptibility profiles and the incidence of multidrug resistant organisms (MDROs) causing PLA in Western countries. Yet, this crucial information is pivotal to guide empirical antibiotic therapy. Aim of this study was to provide detailed characteristics of PLA with a special focus on underlying bacterial pathogens and their susceptibility to antibiotics. Methods A retrospective study of patients diagnosed with PLA from 2009 to 2015 in a large tertiary reference center in Germany was performed in order to characterize PLA and antimicrobial susceptibility profiles of causative bacterial species. Results Overall, 86 patients were included. The most common causes of PLA were bile duct stenosis/obstruction (31.4%) and leakage of biliary anastomosis (15.1%). Frequent predisposing diseases were malignancies (34.9%), diabetes (24.4%) and the presence of liver cirrhosis (16.3%). Of note, Enterococcus spp. were the most frequently cultured bacterial isolates (28.9%), and in 1/3 of cases vancomycin resistance was observed. In addition, a relevant frequency of gram-negative MDROs was identified. In particular, an alarming 10% and 20% of gram-negative bacteria were resistant to carbapenems and tigecycline, respectively. Of note, MDRO status did not predict ICU stay or survival in multivariate regression analysis. The mortality rate in our series was 16.3%. Conclusion Our study demonstrates an as yet underreported role of Enterococcus spp., often associated with vancomycin resistance, as well as of gram-negative MDROs causing PLA. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2543-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcus M Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johanna Kessel
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Internal Medicine 2, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Victoria T Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katharina Schwarzkopf
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Hogardt
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christoph Stephan
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Internal Medicine 2, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian M Lange
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany. .,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.
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48
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Ho SW, Yeh CB, Yang SF, Yeh HW, Huang JY, Teng YH. Pneumonia is an independent risk factor for pyogenic liver abscess: A population-based, nested, case-control study. PLoS One 2017; 12:e0178571. [PMID: 28570670 PMCID: PMC5453545 DOI: 10.1371/journal.pone.0178571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022] Open
Abstract
Background Bacteremic pneumonia is considered a potential cause of distal organ abscess formation. Therefore, we hypothesize that pneumonia is a risk factor for pyogenic liver abscess (PLA).The aim of this study is to explore the association between pneumonia and PLA. Methodology/Principal findings A nationwide, population-based, nested, case–control study was conducted using data from the Taiwan National Health Insurance Research Database. In total, 494 patients with PLA and 1,976 propensity score matched controls were enrolled. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) in patients with exposure to pneumonia before PLA. After matched and adjusted for confounding factors including age, sex, urbanization, income, chronic liver disease, alcohol-related disease, biliary stone, chronic kidney disease, diabetes mellitus, chronic liver disease, and cancer, hospitalization for pneumonia remained an independent risk factor for PLA with an aORs of 2.104 [95% confidence interval (CI) = 1.309–3.379, p = 0.0021]. Moreover, the aORs were significantly higher among patients hospitalized for pneumonia within 30 days (aORs = 10.73, 95% CI = 3.381–34.054), 30–90 days (aORs = 4.698, 95% CI = 1.541–14.327) and 90–180 (aORs = 4.000, 95% CI = 1.158–13.817) days before PLA diagnosis. Conclusion Pneumonia is an independent risk factor for subsequent PLA. Moreover, hospitalization for pneumonia within 180 days before PLA diagnosis was associated with an increased risk of PLA.
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Affiliation(s)
- Sai-Wai Ho
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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49
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Cho H, Lee ES, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, Lee JH, Kim WY, Lim KS. Predictors of septic shock in initially stable patients with pyogenic liver abscess. Scand J Gastroenterol 2017; 52:589-594. [PMID: 28270040 DOI: 10.1080/00365521.2017.1288757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The incidence of pyogenic liver abscess (PLA), a life-threatening condition, is increasing worldwide. This study was designed to evaluate clinical features and outcomes in initially stable patients with PLA and to determine the predictors of septic shock. METHODS The medical records of all adult patients who were hemodynamically stable and diagnosed with PLA in the emergency department from January 2010 to December 2014, inclusive, were reviewed. The primary outcome was septic shock. RESULTS A review of medical records identified 453 patients (66.7% male), of mean age 61.4 years, diagnosed with PLA. Of these patients, 73 (16.1%) had septic shock and 10 (2.2%) died in-hospital. Of the 73 patients with septic shock, nine (12.3%) died in-hospital. The most common symptom was fever (79.5%), and the most common infectious agent was Klebsiella pneumoniae. Septic shock was significantly associated with age ≥60 years [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.38-6.48], malignancy (OR: 2.11, 95% CI: 1.08-4.09), systolic blood pressure <100 mmHg (OR: 3.63, 95% CI: 1.43-9.21), respiratory rate ≥24/min (OR: 3.15, 95% CI: 1.20-8.28) and lactate concentration ≥2 mmol/L (OR: 4.92, 95% CI: 2.51-9.64). Septic shock also tended to be associated with procalcitonin concentration, but this was not statistically significant (OR: 3.42, 95% CI: 0.96-12.18). CONCLUSIONS Septic shock was frequent in initially stable patients with PLA and was associated with older age, malignancy, low blood pressure, tachypnea and elevated lactate concentration.
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Affiliation(s)
- Hyunyoung Cho
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Eu Sun Lee
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Yoon-Seon Lee
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Youn-Jung Kim
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Chang Hwan Sohn
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Shin Ahn
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Dong-Woo Seo
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Jae Ho Lee
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Won Young Kim
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
| | - Kyung Soo Lim
- a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea
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50
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Shi SH, Feng XN, Lai MC, Kong HS, Zheng SS. Biliary diseases as main causes of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Liver Int 2017; 37:727-734. [PMID: 27718321 DOI: 10.1111/liv.13267] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/28/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Little is known about aetiology and morbidity and clinical characteristics of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. METHODS An analysis between pyogenic liver abscess patients caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates and those caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae was performed. RESULTS Among 817 pyogenic liver abscess patients, there were 176 patients (21.5%) with pyogenic liver abscess of biliary origin, and 67 pyogenic liver abscess patients (8.2%) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates (mainly Escherichia coli and Klebsiella pneumoniae). Of 176 pyogenic liver abscess patients related to biliary disorders, there were 48 pyogenic liver abscess patients (27.3%) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Within 67 pyogenic liver abscess patients caused by Enterobacteriaceae expressing extended-spectrum beta-lactamases, the occurrences of 48 pyogenic liver abscess patients (71.6%) were associated with biliary disorders. When compared with pyogenic liver abscess patients caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae, there were significantly greater incidences of polymicrobial infections, bacteremia, pulmonary infection, recurrence and death in pyogenic liver abscess patients caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Carbapenems remain mainstay drugs against extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae. Independent risk factors for occurrence of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae were biliary disorders including extra- and intrahepatic cholangiolithiasis and an abnormal bilioenteric communication between bile and gut, a treatment history of malignancy such as operation and chemotherapy, pulmonary infection, and diabetes mellitus. CONCLUSIONS Pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates mainly occurs in patients with biliary disorders or with a treatment history of malignancy. The mainstay of treatment remains carbapenems in combination with adequate aspiration or drainage.
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Affiliation(s)
- Shao-Hua Shi
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao-Ning Feng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ming-Chun Lai
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hai-Shen Kong
- Clinical Lab of Microbiology, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
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