Incidence Trends, Comorbidities, and Outcomes of Pyogenic Liver Abscess Among Children

Abstract

Objectives: Population-based analysis of incidence, comorbid conditions, microbiological characteristics, and outcomes of pyogenic liver abscess (PLA) in children. Methodology: Retrospective analysis of National Inpatient Sample (NIS) and Kids Inpatient database (KID) database from 2003 to 2014 and included patients between 1 and 20 years of age. Using ICD-9 codes, we identified all hospitalizations with PLA and compared them with 1 : 10 age- and gender-matched controls. Amebic liver abscess and Candida infections were excluded. Results: Total number of PLA admissions is 4075. The overall incidence of PLA is 13.5 per 100,000 hospitalizations, which increased by 60% between 2003 and 2014. The mean age of patients was 13.03 ± 6.1 years and were predominantly boys—61%. Of the comorbid conditions, hepatobiliary malignancy had the highest odds ratio (OR 71.8) followed by liver transplant (OR 38.4), biliary disease (OR 29.9), inflammatory bowel disease (IBD) (OR 5.35), other GI malignancies (OR 4.74), primary immune deficiency disorder (OR 4.13). Patients with PLA had 12 times increased odds of having associated severe sepsis. Infective endocarditis (IE) (OR 4.5), appendicitis (OR 1.8), and diverticulitis (OR 8.1) were significantly associated with PLA. Almost 39% (1575) of the PLA patients had positive culture, whereas Streptococcus (10.8%) and Staphylococcus spp (9.2%) were the most common pathogens. About 45% of PLA patients underwent percutaneous liver abscess aspiration whereas 4.1% had hepatic resection for PLA. The mortality rate of PLA was 0.8% (n = 32). Conclusions: The incidence of PLA is steadily increasing over the last decade among pediatric population in the United States. Hepatobiliary malignancy and liver transplant are the most common comorbid conditions associated with PLA.

Liver abscesses in the Western pediatric population

“…This is, to the best of our knowledge, the largest series of pediatric liver abscesses in Europe. Our positive culture rate for invasive culture specimens is in line with the literature (1,11,13,16), however great variation exists between studies. Reported rates range from 39% to 73.3% and not all reports differentiate between positive blood culture results and invasive culture results.…”

“…As of interventional treatment, surgical drainage was performed more frequently than percutaneous drainage in our cohort. This is in contrast with many other reports (4,9,11,16,20,21), where percutaneous drainage was the most frequently employed approach. Since in our population the proportion of patients with hepatobiliary disease leading to liver transplantation and intra-abdominal surgical pathology was relatively high, this might explain the relative predominance of surgical drainage.…”

“…Staphylococcus aureus has been reported as the most prevalent causative pathogen in pediatric liver abscesses in most series from both the developed as the developing world (1,6,12,16,17). Recent data from the United States however, showed that prevalence of Streptococci preceded that of Staphylococci.…”

“…In cases of children undergoing antineoplastic therapy, the occurrence of any deep pyogenic infection is linked to prolonged periods of neutropenia (9,30). In a recent nation-wide retrospective analysis in the United States (16), liver transplantation was the single most important risk factor for liver abscess development in children.…”

Endocarditis in Liver Transplant Recipients: A Systematic Review

“…Additionally, two studies were included after reference search of the abovementioned studies. Finally, 39 studies met the present study’s inclusion criteria [ 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Additional information was kindly provided by the corresponding authors of two studies [ 40 , 48 ].…”