Increased incidence of and microbiologic changes in pyogenic liver abscesses in the Mexican population

Abstract

BACKGROUND Pyogenic liver abscess (PLA) is a rare disease with an estimated incidence that varies widely across the globe, being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada. Even though there are multiple microorganisms capable of producing an abscess in the liver, including Entamoeba histolytica , fungi, and viruses, most abscesses are derived from bacterial infections. The epidemiology of PLA in Mexico is currently unknown. AIM To describe the clinical, demographic and microbiologic characteristics of PLA in Mexico. METHODS This is a retrospective study carried out in two centers, and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess. We collected demographic, clinical, and microbiological information, treatment, complications, and outcomes. A logistic regression analysis was used to determine the association between different variables and mortality rates. RESULTS A total of 345 patients were included in this study. 233 (67.5%) had confirmed PLA, 133 (30%) patients had no positive culture and negative serology and 9 (2.5%) had mixed abscesses. The mean age was 50 years (ranging from 16-97 years) and 63% were female. 65% of the patients had positive cultures for Extended Spectrum Beta-Lactamases (ESBL)- Escherichia coli and Klebsiella pneumoniae . Cefotaxime was administered in 60% of cases. The most common sources of infection were ascending cholangitis and cholecystitis in 34 (10%) and 31 (9%), respectively. The median length of hospital stay was 14 d. 165 patients underwent percutaneous catheter drainage. The inpatient mortality rate was 63%. Immunocompromised state [OR 3.9, 95%CI: 1.42-10.46], ESBL- Escherichia coli [OR 6.7, 95%CI: 2.7-16.2] and Klebsiella pneumoniae [OR 4-8, 95%CI: 1.6-14.4] predicted inpatient mortality by multivariate analysis. CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate. ESBL- Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.

Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

“…The finding that most of our patients with liver abscesses were relatively young at presentation (median age 39 years for ALA and 46 years for PLA) concurs with previous reports from our region [ 11 – 13 ]. However, it contrasts with reports from the Western hemisphere in which older age at presentation was documented [ 2 , 10 , 14 – 16 ]. Male preponderance was evident in our series (87.5% for ALA, 75.7% for PLA) and is consistent with similar studies from our region [ 11 – 13 ].…”

The New Changes of Epidemiology, Etiology, and Clinical Characteristics of Pyogenic Liver Abscesses: A Retrospective Study in a Hospital in Northern China

“…34 The results of this study revealed that 13.9% of the patients suffered from septic shock, which is consistent with previous reports. [35][36][37] There has been no significant change in the incidence of septic shock over several years. Multivariate analysis identified coexisting DM and gas formation as risk factors for septic shock in PLA patients.…”

Clinical efficacy of ulinastatin in the treatment of unliquefied pyogenic liver abscess complicated by septic shock: A randomized controlled trial

“…The incidence of PLA is higher in Asia compared to Europe and the United States, with an annual incidence of 1.1−5.4/100,000 in China 3 , 4 and up to 17.6/100,000 in Taiwan, and 1.0−4.1/100,000 in European countries and America. 5 , 6 , 7 Due to the rapid advances in medical technology, the diagnosis and treatment of PLA have greatly improved, resulting in a decrease in mortality rates from >80% at the beginning of the previous century to <10%. 8 , 9 In the most recent decade, the changing diet and aging of the global population, coupled with the emergence of diabetes, malignant tumors, and multidrug resistant highly virulent pathogens, account, at least in part, for the annual increase in incidence and mortality rate of PLAs.…”

“…Pyogenic LA (PLAs) account for >80% of LA morbidity. The incidence of PLA is higher in Asia compared to Europe and the United States, with an annual incidence of 1.1−5.4/100,000 in China 3,4 and up to 17.6/100,000 in Taiwan, and 1.0−4.1/100,000 in European countries and America 5–7 . Due to the rapid advances in medical technology, the diagnosis and treatment of PLA have greatly improved, resulting in a decrease in mortality rates from >80% at the beginning of the previous century to <10% 8,9 .…”