Clinical manifestations and etiological analysis of 56 patients with liver abscess

Abstract

Abstract: Objective To review the clinical data of patients with pathogen-positive liver abscess (LA) and compare it with pathogen-negative liver abscess, so as to provide guidance for clinical condition evaluation and treatment strategy formulation of liver abscess. Methods From January 2017 to December 2020, 62 LA patients (43 males and 19 females) were collected, aged 55 (40, 68) years. To compare the clinical data of patients with pathogen-negative and pathogen-positive LA. According to different pathogenic bacteria, pathogen-positive LA was divided into Escherichia coli group (EC group) and Klebsiella pneumoniae group (KP group), and the clinical data were compared. Results There were 40 patients with pathogen-negative LA and 22 patients with pathogen-positive LA. The patients with pathogen-negative and pathogen-positive LA were 53 (40, 70) years old and 58 (46, 66) years old, and the difference was statistically significant (P<0.05). There were 7 cases (17.5%) and 9 cases (40.9%) of diabetes in pathogen-negative and pathogen-positive LA patients, and the difference was statistically significant (P<0.05). The white blood cell (WBC), neutrophil percentage, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and total bilirubin (Tbil) in patients with pathogen-positive liver abscess were 11.6 (2.6, 18.2)×10⁹/L, 80.2 (36.0, 96.4)%, 56 (22, 214) U/L, 67 (18, 202) U/L and 24.6 (6.8,34.8) μmol/L, compared with 14.5 (3.3, 30.8)×109/L, 86.2 (68.3, 98.6)%、126 (20, 462) U/L, 144 (16, 507) U/L and 28.8 (10.1, 48.4) μmol/L in pathogen-negative LA, the difference was statistically significant (P<0.05). The diameters of abscesses in patients with pathogen-negative and pathogen-positive LA were 4.2 (3.0, 5.8) cm and 5.5 (4.0, 7.0) cm, with statistical significance (P<0.05). The EC and KP pathogens in pathogen-positive LA patients were 16 cases (EC group) and 6 cases (KP group), respectively. According to the clinical data of the two groups, the age, male, diabetes and abdominal pain in EC group were 52 (45,66) years old, 12 cases (75.0%), 9 cases (56.2%) and 4 cases (25.0%), compared with those in KP group [61 (52,70) years old, 2 cases (33.3%), 0 (0) and 4 cases (66.7%)], with statistical significance (P<0.05). The ALP, GGT and TBil in EC group were 115 (14,450) U/L, 126 (12, 480) U/L and 23.7 (9.6, 20.4) μmol/L, which were higher than those in KP group [141 (94, 670) u/l, 170 (84, 507)U/L and 34.5 (18.7, 52.5) μmol/L (P<0.05). There were 3 cases (18.7%), 4 cases (25.0%) and 3 cases (18.7%) with multiple purulent cavities, gas formation of purulent cavities and separation of purulent cavities in EC group, and the difference was statistically significant compared with KP group [5 cases (83.3%), 0 cases (0) and 0 cases (0)] (P<0.05). The treatment strategy is anti-infection combined with ultrasound or CT guided abscess puncture drainage. Three generations of cephalosporins combined with ornidazole and β-lactamase inhibitors were selected as the anti-infection scheme. There were 29 cases (72.5%) and 16 cases (72.7%) of patients with negative and positive LA treated well, respectively, and the difference was not statistically significant (P>0.05). There was no significant difference between the two groups in hospital stay [(18.8 ± 5.2) days vs (17.0 ± 5.0) days, P>0.05]. There was no significant difference in hospitalization time between EC group and KP group [(18.5 ± 5.0) days compared with (19.4 ± 6.0) days, P>0.05]. Conclusion Patients with pathogen-negative LA are younger, so they are less likely to have severe inflammatory reaction and hepatic insufficiency. If pyogenic gas and pyogenic cavity are formed in pathogen-positive LA patients, KP infection is more likely. There is no significant difference in the overall prognosis of LA patients in each group.

Key words: Liver abscess, Escherichia coli, Klebsiella pneumoniae

WANG Jun, YANG Liu-qing. Clinical manifestations and etiological analysis of 56 patients with liver abscess[J]. Chinese Hepatolgy, 2022, 27(9): 1021-1024.

References

[1] Lee YT, Wang CC, Li CF, et al. Utility of acute physiology and chronic health evaluation (APACHE II) in predicting mortality in patients with pyogenic liver abscess: a retrospective study. J Clin Med, 2021, 10(12):2644.
[2] Li S, Yu S, Peng M, et al. Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases. BMC Infect Dis, 2021, 21(1):597.
[3] Geetha O, Cherie C, Natalie TWH, et al. Streptococcus gallolyticus subspecies pasteurianus causing early onset neonatal sepsis complicated by solitary liver abscess in a preterm infant. Access Microbiol, 2021, 3(3):000200.
[4] Zhang S, Zhang X, Wu Q, et al. Clinical, microbiological, and molecular epidemiological characteristics of Klebsiella pneumoniae-induced pyogenic liver abscess in southeastern China. Antimicrob Resist Infect Control, 2019, 8:166.
[5] Guo Y, Wang S, Zhan L, et al. Microbiological and clinical characteristics of hypermucoviscous klebsiella pneumoniae isolates associated with invasive infections in China. Front Cell Infect Microbiol, 2017, 7:24.
[6] Liu C, Guo J. Hypervirulent Klebsiella pneumoniae (hypermucoviscous and aerobactin positive) infection over 6 years in the elderly in China: antimicrobial resistance patterns, molecular epidemiology and risk factor. Ann Clin Microbiol Antimicrob, 2019, 18(1):4.
[7] Yin D, Ji C, Zhang S, et al. Clinical characteristics and management of 1572 patients with pyogenic liver abscess: a 12-year retrospective study. Liver Int, 2021, 41(4):810-818.
[8] Yang Q, Jia X, Zhou M, et al. Emergence of ST11-K47 and ST11-K64 hypervirulent carbapenem-resistant Klebsiella pneumoniae in bacterial liver abscesses from China: a molecular, biological, and epidemiological study. Emerg Microbes Infect, 2020, 9(1):320-331.
[9] Qian Y, Wong CC, Lai S, et al. A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015. Sci Rep, 2016, 6:38587.
[10] Shi SH, Feng XN, Lai MC, et al. Biliary diseases as main causes of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Liver Int, 2017, 37(5):727-734.
[11] 张鸣, 刘杨, 朱剑清, 等. 细菌性肝脓肿310例临床分析. 中国感染与化疗杂志, 2018, 18(4): 372-376.
[12] Shelat VG, Chia CL, Yeo CS, et al. Pyogenic liver abscess: does escherichia coli cause more adverse outcomes than klebsiella pneumoniae? World J Surg, 2015, 39(10):2535-2542.
[13] Lin YT, Pan YJ, Lin TL, et al. Transfer of CMY-2 cephalosporinase from Escherichia coli to virulent Klebsiella pneumoniae causing a recurrent liver abscess. Antimicrob Agents Chemother, 2015, 59(8):5000-5002.
[14] Patel G, Shah N, Sharma R. Pyogenic liver abscess, bacteremia, and meningitis with hypermucoviscous Klebsiella pneumoniae: an unusual case report in a human T-cell lymphotropic virus positive patient of caribbean origin in the United States. Case Rep Infect Dis, 2013, 2013:676340.
[15] Liu Y, Wang JY, Jiang W. An increasing prominent disease of Klebsiella pneumoniae liver abscess: etiology, diagnosis, and treatment. Gastroenterol Res Pract, 2013, 2013:258514.