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Factors associated with increased incidence in pyogenic liver abscess based on cases reported in the National Health Insurance database, Taiwan, 2004*
Source publication
Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a population-based study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance...
Contexts in source publication
Context 1
... factors were associated with the increased in- cidence of liver abscess. Because incidence data from each year could not be merged directly, we chose the cases re- ported in 2004 to evaluate the relative risk for each factor (Table 3). Diabetes mellitus and malignancy were asso- ciated with a ≈10-fold increased risk, while renal disease and pneumonia tripled and quadrupled the incidence of liver abscess, respectively. ...
Context 2
... in contrast to the comprehensive data of pyogenic liver abscess, detailed health data for each person in the population are not avail- able. We are therefore unable to estimate the interaction among the risk factors of pyogenic liver abscess in the pop- ulation (Table 3). Nevertheless, this study still provides a clear picture of pyogenic liver abscess in Taiwan. ...
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Background:
Etiologic organism is not frequently isolated despite multiple blood and fluid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogenic liver abscess (CNPLA) is routinely managed by antibiotics targeted to Klebsiella pneumoniae. In this study, we evaluated the outcomes of such clinical practice.
Metho...
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Citations
... Although hypervirulent Klebsiella strains are emerging pathogens in Western countries, they still play a minor role in the etiology of LA in this part of the world 20,21 . However, there is evidence that LA is an infectious disease with a markedly increasing incidence in both Western countries and Asia 4,15,16,18,19 . ...
Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.
... The incidence of liver abscess is gradually increasing globally and around 2.30-17.59 per 100,000 per year 4 . Liver abscess is still a common infection in developing countries like India. ...
... Pyogenic liver abscess (PLA) is an infectious disease caused by pyogenic bacteria that invade the liver through various routes and form solitary or multiple collections of pus within the liver. 1,2 In recent years, there has been a noticeable rise in the incidence rate of PLA in adults in China and Korea. [3][4][5] The incidence of liver abscesses is also on the rise among children in the United States. ...
Purpose
The clinical manifestations of pyogenic liver abscess (PLA) vary between patients with and without diabetes mellitus (DM). However, the relationship between PLA and the gut microbiome remains unknown. This study analyzed the composition of gut microbiota in PLA patients with and without DM and healthy controls (HCs) with the goal of identifying potential reasons for the observed variations in clinical manifestations.
Patients and Methods
Using 16S ribosomal RNA(16S rRNA) gene sequencing, we analyzed the compositions of gut microbiota in 32 PLA patients with DM, 32 PLA patients without DM, and 29 matched HCs.
Results
In PLA patients with DM, the D-dimer level, fibrinogen degradation products, and thrombin time were significantly higher compared to the PLA patients without DM (P < 0.05). The abundance and diversity of intestinal flora were reduced in both groups of PLA patients compared with the HCs (P < 0.05). Specifically, the PLA patients with DM showed significant decreases in the relative abundances of Bacteroides, Blautia, Prevotella9, and Faecalibacterium, whereas Enterococcus and Escherichia-Shigella were relatively more abundant (P < 0.05). Compared to PLA patients without DM, those with DM had lower relative abundances of Lactobacillus and Klebsiella (P < 0.05) and showed different bacterial flora, including Anaerosporobacter and Megamonas.
Conclusion
PLA patients with DM exhibited more severe clinical manifestations of PLA compared to patients without DM. It is important to monitor blood coagulation in PLA patients with DM to prevent the development of thrombotic diseases. Additionally, PLA patients with DM exhibit distinct differences in the composition and diversity of their intestinal flora compared to both PLA patients without DM and HCs.
... Gram-negative enterobacteria were the most common pathogens, with K. pneumoniae accounting for 60.9% and E. coli accounting for 8.2%. Previous studies have shown that K. pneumoniae is more common than E. coli as the cause of liver abscesses, accounting for 60-80% of all cases of PLA in China and other Asian countries [11][12][13]. Antibiotic resistance has become a major public health issue worldwide, and the incidence of PLA caused by antimicrobial-resistant bacteria has increased in recent years [8]. In this study, 55 (23%) patients had MDRO infections, and ESBL-producing bacteria were most common, accounting for 61.0% of the MDRO, followed by carbapenem-resistant bacteria (32%). ...
The incidence rate of pyogenic liver abscess caused by multidrug-resistant bacteria has increased in recent years. This study aimed to identify the clinical characteristics and risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. We conducted a retrospective analysis of the clinical features, laboratory test results, and causes of pyogenic liver abscesses in 239 patients admitted to a tertiary hospital. Multivariable logistic regression was used to identify risk factors for multidrug resistance. Among patients with pyogenic liver abscesses, the rate of infection caused by multidrug-resistant organisms was observed to be 23.0% (55/239), with a polymicrobial infection rate of 14.6% (35/239). Additionally, 71 cases (29.7%) were associated with biliary tract disease. Patients with pyogenic liver abscesses caused by multidrug-resistant organisms had a significantly higher likelihood of polymicrobial infection and increased mortality (7/44 [15.9%] vs. 3/131 [2.3%]; p = .003). The Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.06–1.68), hospitalization (aOR: 10.34, 95% CI: 1.86–60.3) or an invasive procedure (aOR: 9.62; 95% CI: 1.66–71.7) within the past 6 months, and gas in the liver on imaging (aOR: 26.0; 95% CI: 3.29–261.3) were independent risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. A nomogram was constructed based on the risk factors identified. The nomogram showed high diagnostic accuracy (specificity, 0.878; sensitivity 0.940). Multidrug-resistant organisms causing pyogenic liver abscesses have specific characteristics. Early identification of patients at high risk of infection with multidrug-resistant organisms could help improve their management and enable personalized treatment.
... Many HvKp cases likely go undetected or unreported in these countries, in contrast to high-income neighbours such as Taiwan and South Korea. Between 1996 and 2004, an almost 60% increase in the annual incidence of liver abscesses caused by HvKp was observed in Taiwan [76]. In South Korea, the proportion of liver abscesses caused by K. pneumoniae rose from 3.3% in the 1970s to 78.2% in the mid-2000s [77]. ...
The World Health Organization (WHO)’s list of neglected tropical diseases (NTDs) highlights conditions that are responsible for devastating health, social and economic consequences, and yet, they are overlooked and poorly resourced. The NTD list does not include conditions caused by Gram-negative bacilli (GNB). Infections due to GNB cause significant morbidity and mortality and are prevalent worldwide. Southeast Asia is a WHO region of low- and middle-income countries carrying the largest burden of NTDs. Two significant health threats in Southeast Asia are Burkholderia pseudomallei (causing melioidosis) and hypervirulent Klebsiella pneumoniae (HvKp). Both diseases have high mortality and increasing prevalence, yet both suffer from a lack of awareness, significant under-resourcing, incomplete epidemiological data, limited diagnostics, and a lack of evidence-based treatment. Emerging evidence shows that both melioidosis and HvKp are spreading globally, including in high-income countries, highlighting the potential future global threat they pose. In this article, we review both conditions, identifying current trends and challenges in Southeast Asia and areas for future research. We also argue that melioidosis and HvKp merit inclusion as NTDs, and that mandatory global surveillance and reporting systems should be established, and we make an urgent call for research to better understand, detect, and treat these neglected diseases.
... Частота их состав ляет 50-70% [2], а летальность в послеоперационном периоде после развития осложнений может достигать 90% [3,4]. Как острый, так и хронический рецидивирующий холангит может приводить к холангиогенному абсцедированию в печени и сепсису, которые сопровождаются высокой летальностью при отсутствии адекватного лечения [5][6][7][8][9][10]. ...
Aim. To develop the concept of prevention and treatment of severe complications after radical surgery for portal cholangiocarcinoma based on a comparative analysis of two periods of the surgical treatment program.
Materials and methods. The study involved an analysis of multidisciplinary treatment of patients with portal cholangiocarcinoma for 8 years (2013–2020). The study consisted of two stages: program formation in 2013–2018 and evaluation of results in 2019–2020.
Results. 140 patients with portal cholangiocarcinoma underwent radical or relatively radical surgery: 94 patients in the first period and 46 patients in the second period. 35 pairs of observations were formed by means of propensity score matching. In the second period, the incidence of Clavien-Dindo grade IV and V complications, CCI>40 index, duration of stay in the intensive care unit, and 90-day mortality significantly decreased. Proven reasons for the improvements included more thorough preparation of patients for the resection stage of treatment, elimination of clinical and laboratory manifestations of biliary drainage complications, careful invasive monitoring of fluid accumulations, and prevention of cholangitis.
Conclusion. Maximum compensation of inflammatory and trophic disorders, elimination of jaundice, prevention and early elimination of complications as a result of their prognosis and monitoring at all stages of treatment reliably improve the immediate results of radical surgery for portal cholangiocarcinoma.
... The incidence of the disease varies according to the geographical location of reference, with a clear difference between East and West. Recent studies have shown that in Europe and America the hepatic abscess presents with 1.1-3.6 cases per 100,000 inhabitants, while in Asia there is a rate of 17.6 cases per 100,000 inhabitants [6][7][8]. Nevertheless, it is considered an uncommon cause of liver disease [9,10]. ...
Background: Pyogenic hepatic abscess (PHA) is an uncommon infectious disease of the liver that should represents a life-threatening condition if not correctly diagnosed and managed. Nowadays there are not precise indications and clear evidences on the best therapeutic approach and on the superiority of a treatment. Methods: Patients with diagnosis of PHA admitted at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and December 2022 were identified in a prospective database. Among the demographic, epidemiological and clinical data collected we included the therapeutic choices – antibiotic treatment, image guided percutaneous drainage and surgical operation – and their effect in terms of healing time, treatment failure and time of hospitalization. Results: Patients with single abscesses treated with antibiotics have significant high healing time (p=0.0001) and in-hospital time (p=0.0001) and no differences in treatment failure than patients treated with invasive techniques. Patients that underwent surgical operation have significant higher healing time than percutaneous group (p=0.002) such as higher mean hospital stay (p=0.03 for abscesses <5 cm and p=0.02 for abscesses larger than 5 cm). The last, the percutaneous approach shows a failure rate significantly higher than the surgical procedure (p=0.009 for abscesses <5 cm and p=0.001 for abscesses larger than 5 cm). Conclusions: The study proposed showed the antibiotic therapy is the first line treatment and should first empirically and then directly modified on specimen culture results. Image guided percutaneous drainage should be considered when the antibiotic therapy alone is not sufficient or as bridge to surgery if surgical indications are proven.
... In recent decades, improved diagnostic techniques (ultrasound, computed tomography, ultrasound-guided puncture) and antibiotic therapy combined with percutaneous drainage have considerably improved patient prognosis [3,4]. Bacteria such as enterobacteria (Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa), staphylococcus, streptococcus and anaerobes are the most frequently associated with pyogenic liver abscesses [5,6]. ...
Background: The incidence of pyogenic liver abscess (PLA) has increased in recent years with the development of digestive surgery, particularly hepatobiliary surgery. In recent decades, progress in diagnostic techniques have improved patient prognosis. In Senegal, there are few studies of PLA. This study was carried out within this context. Objective: The main objective was to describe the profile and the management of pyogenic liver abscesses cases in rural Senegal. Results: We collected 17 cases of PLA among 47.553 patients, during the study period, representing a hospital frequency of 0.035%. The mean age of patients was 48.6 ± 18.9. The sex ratio (M/F) was 2:4. Most of the patients (58.82%) had at least one risk factor, the main ones being smoking, a history of abdominal surgery and alcoholism. Right upper abdominal pain was the main reason for consultation (94.11%). Right basithoracic pain and cough were the most frequent respiratory symptoms. Escherichia coli remained the most frequently isolated bacteria. The mean time to diagnosis was 17.8 days ± 14.4. All patients received antibiotic therapy, which was combined with echo-guided liver aspiration in 58.82% cases. Mean hospital stay was 17.5 days ± 7.65. The hospital lethality rate was 29.41%. Conclusion: Liver abscesses are most often of amoebic origin in our context, but in recent years there has been an increase in cases of pyogenic liver abscesses, with the progress made in diagnosis.
... In total, three EnE case series have been identified in Taiwan since 2000 [55][56][57] (Table 3). Six studies of pyogenic liver abscess with incidence of subsequent EnE were collected from 2000 [58][59][60][61][62][63]. A decreasing trend in endophthalmitis rates in patients with pyogenic liver abscess was noted throughout the study period (Table 4). ...
Clinical practices on acute post-operative and endogenous endophthalmitis (EnE) are highly variable among clinicians due to a lack of up-to-date, high-quality evidential support. An expert consensus is thus much needed. A panel consisting of ten retinal specialists in Taiwan was organized. They evaluated relevant literature and developed key questions regarding acute post-operative and EnE that are cardinal for practice but yet to have conclusive evidence. The panel then attempted to reach consensus on all the key questions accordingly. There were eight key questions proposed and their respective consensus statements were summarized as follows: Gram staining and culture are still the standard procedures for the diagnosis of endophthalmitis. Vitrectomy is recommended to be performed earlier than the timing proposed by the Endophthalmitis Vitrectomy Study (EVS). Routine intracameral antibiotic injection for post-cataract surgery endophthalmitis prophylaxis is not recommended because of potential compounding error hazards and a lack of support from high-quality studies. Routine fundus examination is recommended for all patients with pyogenic liver abscess. In EnE, vitrectomy is recommended if diffused and dense vitritis is present, or if the disease progresses. These consensus statements may work as handy guidance or reference for clinical practices of acute post-operative and EnE.
... In Asia, K. pneumoniae has become the predominant pathogen causing PLAs. 19,20 This study revealed a year-by-year increase in the proportion of K. pneumoniae in the pus or blood culture of PLA patients, with a significant increase to 81.8% in the last two years. Previous studies have shown that DM is the most common underlying disease in patients with K. pneumoniae liver abscesses (KPLAs). ...
Purpose
To investigate the epidemiology, etiology, and clinical characteristics of patients with pyogenic liver abscesses (PLA) and provide guidance for clinical treatments.
Patients and Methods
A retrospective study was performed on a cohort of 402 hospitalized patients diagnosed with PLAs at the Affiliated Hospital of Chengde Medical College between January 2016 and December 2021. Patient demographics, drug sensitivity profiles, and microbiological culture results of drainage and blood samples were thoroughly analyzed to identify significant patterns or trends. Furthermore, clinical characteristics and treatments for patients with PLA were comprehensively assessed.
Results
Patients aged 50–69 years had the highest incidence of PLA, accounting for 59.9% of all cases, and 91.5% of them had a fever. Bacterial culture analysis of the 200 patients revealed that Klebsiella pneumoniae (K. pneumoniae) was the most predominant pathogen, detected in 70.5% of cases, exhibiting an upward trend. Escherichia coli (E. coli) was the second most frequently detected pathogen, identified in 14.5% of cases, showing a downward trend. Coexisting diabetes mellitus (DM) was found to be the most common comorbidity for PLA, occurring in most patients with the condition. Patients with a history of abdominal surgery and malignancy had an increased risk for PLA, while those with gallstones had a decreased risk. Drainage combined with antibiotic therapy was identified as the primary treatment of PLA. In addition, multivariate analysis demonstrated that coexisting DM and the presence of gas in the abscess cavity were independent risk factors for septic shock in patients with PLA.
Conclusion
This study reveals a shift in the proportions of pathogens and risk factors in patients with PLA, underscoring the necessity for improved diagnostic and therapeutic strategies.
