A Multicenter Retrospective Study on Clinical Characteristics and Outcome of Pyogenic Liver Abscess Focusing Multidrug-Resistant Organisms

Abstract

The emergence of multidrug-resistant organisms (MDROs) is a growing problem worldwide. However, little is known about the incidence, clinical features and outcomes of pyogenic liver abscesses (PLAs) caused by MDROs. A retrospective study of 833 patients with PLA admitted from 2008 to 2017 was performed. MDROs were found in 55 (6.6%) patients, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was the most common causative microorganism. To evaluate the clinical features of and risk factors for MDRO-induced PLAs, propensity score matching (PSM) was performed in a 1:3 ratio (55 patients with MDROs and 165 patients without MDROs). After PSM, previous hepatobiliary procedure, preadmission exposure to antibiotics and elevated alkaline phosphatase levels were independent risk factors for MDRO-induced PLA. Sixteen patients (7.3%) died during hospitalization. Admission to intensive care unit (ICU), inadequate initial antibiotic treatment and use of inotropic agents were factors predictive of mortality. Although the presence of MDROs was not associated with in-hospital mortality, inadequate initial antibiotic treatment was prescribed to a large portion of the patients with MDRO-induced PLAs. We conclude that initial empirical antibiotic therapy for PLA should be based on the possibility of infection with MDROs, and close monitoring is necessary for patients with risk factors for in-hospital mortality.

Clinical features and risk factors for pyogenic liver abscess caused by multidrug-resistant organisms: A retrospective study

“…Carbapenem-resistant K. pneumoniae (CRKP) was the most common of the carbapenem-resistant bacteria. A study conducted in South Korea [ 14 ] evaluated 833 patients with PLA from 2008 to 2017 and found that 6.6% of cases of PLA were caused by MDRO, which lower than the prevalence observed in this study. The presence of anaerobic bacteria and other rare pathogens may have been underestimated because conventional bacterial culture may not detect atypical pathogens.…”

Platelet-to-White Blood Cell Ratio: A Feasible Biomarker for Pyogenic Liver Abscess

“…In addition, recent studies have reported a rapid increase in the incidence of PLA in Asia, especially Korea [ 7 , 11 ]. This phenomenon is known to be related to an increase in the numbers of older patients and patients with underlying diseases such as cancer, cirrhosis and chronic renal failure [ 7 , 10 ] and increasing infections with not only Klebsiella pneumoniae (K. pneumoniae ) [ 7 , 12 ] but also multidrug-resistant organisms [ 13 ]. In clinical settings, the initial recommended treatment for PLA is the use of empiric antibiotic regimens such as amoxicillin-clavulanic acid, third-generation cephalosporins combined with an aminoglycoside, or piperacillin/tazobactam [ 14 ].…”