Epidemiology and risk factors for pyogenic liver abscess in the Calgary Health Zone revisited: a population-based study

Abstract

Background Pyogenic liver abscess (PLA), although uncommon in North America, is associated with significant morbidity and mortality. We sought to re-examine the epidemiology, risk factors, and outcomes of PLA in a large, diverse Canadian health zone. Methods All Calgary Health Zone (CHZ) residents aged ≥20 with PLA between 2015 and 2017 were identified. Incidence and mortality rates were calculated using census data. Risk factors for PLA were identified using a multivariate analysis. Data was compared to 1999–2003 data, also collected in the CHZ. Results There were 136 patients diagnosed with PLA between 2015 and 2017. Incidence rate during this period increased significantly relative to 1999–2003 (3.7 vs 2.3 cases/100,000 population, p < 0.01), however, mortality rates remained similar. The microbiological composition of PLA did not change over this 15-year time period but the number of antimicrobial resistant isolates did increase (8% vs 1%, p = 0.04). The greatest risk factors for PLA relative to general populations included current malignancy, liver-transplant, end-stage renal disease, and cirrhosis. Thirty-day mortality was 7.4% and independent risk factors included polymicrobial bacteremia, absence of abscess drainage, congestive-heart failure, a history of liver disease, and admission bilirubin. Conclusions Pyogenic liver abscess is a health concern with rising incidence rate. The increasing prevalence of comorbidities in our population and factors that are associated with risk of PLA suggests this will continue to be an emerging diagnosis of concern. Increasing prevalence of antibiotic resistant organisms compounding unclear optimal treatment regimens is an issue that requires urgent study.

Liver abscess in advanced hepatocellular carcinoma after atezolizumab plus bevacizumab treatment: A case report

“…[6] Risk factors for pyogenic liver abscesses include malignancy, diabetes, ischemic heart disease, chronic obstructive pulmonary disease, cirrhosis, renal failure, and liver transplant. [7] In the present case, CT showed CBD stones but no evidence of obstructive jaundice, such as IHBD to CBD dilation on CT or cholangitis in the CBD on postmortem examination. The occurrence of liver abscesses after treatment with radiofrequency ablation or TACE for HCC has been reported in many cases, with a frequency of 1.5%-2.4% after radiofrequency ablation [8] and 0%-3.3% after TACE.…”

“…[ 6 ] Risk factors for pyogenic liver abscesses include malignancy, diabetes, ischemic heart disease, chronic obstructive pulmonary disease, cirrhosis, renal failure, and liver transplant. [ 7 ] In the present case, CT showed CBD stones but no evidence of obstructive jaundice, such as IHBD to CBD dilation on CT or cholangitis in the CBD on postmortem examination.…”

A rare Danish case of Yersinia pseudotuberculosis pyogenic liver abscess

“…The usual regime includes 2 weeks of parental antibiotic treatment followed by 4 to 6 weeks of oral antibiotics. 5 The optimal antibiotic treatment and duration of antimicrobial treatment for Y. pseudotuberculosis PLA is unknown, and was heterogeneously reported in the published cases. 9-14 Y. pseudotuberculosis is usually in vitro susceptible to ampicillin, cephalosporins, tetracycline, ciprofloxacin, and aminoglycosides, 1,2 and the recommended antibiotic therapy in case of bacteremia or systemic infection includes a third-generation cephalosporin such as ceftriaxone 2 g per day (or alternatively ciprofloxacin) combined with a daily dose of gentamycin 5 mg/kg.…”

“…Treatment of PLA includes drainage (either percutaneous or surgical) and antibiotic therapy. The usual regime includes 2 weeks of parental antibiotic treatment followed by 4 to 6 weeks of oral antibiotics 5 . The optimal antibiotic treatment and duration of antimicrobial treatment for Y. pseudotuberculosis PLA is unknown, and was heterogeneously reported in the published cases 9–14 .…”

“…A pyogenic liver abscess (PLA) is pus‐filled cavity within the liver due to a bacterial infection 3 . The annual incidence of PLA has been reported between 1 and 7 cases per 100,000 in some Western Countries and higher among men than women, 4–6 while higher rates have been reported in Taiwan (17.6 per 100,000) with Klebsiella pneumoniae as the primary pathogen 7 . The majority of PLA occurs in patients with pre‐existing gastrointestinal or biliary disease and originates from hematogenous spread though the portal vein.…”