Outcomes of Gas-Forming Pyogenic Liver Abscess Are Comparable to Non-Gas-Forming Pyogenic Liver Abscess in the Era of Multi-Modal Care: A Propensity Score Matched Study

Chan, Kwai S.; Thng, Coeway Boulder; Chan, Yiong‐Huak; Shelat, Vishal G

doi:10.1089/sur.2019.278

Cited by 13 publications

(16 citation statements)

References 28 publications

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“…GFPLA represents a small proportion of PLA with a reported incidence of 7%-24%, and it has traditionally been associated with high mortality (25.7% to 37.1%). In one study, Chan et al[ 24 ] reported no significant differences between GFLPA and non-GFLPA in the need for percutaneous drainage [26/36 (72.2%) vs 47/72 (65.3%), respectively, P = 0.467] and in-hospital all-cause death [4/36 (11.1%) vs 7 (9.7%), P = 0.822].…”

Section: Discussionmentioning

confidence: 99%

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

Pérez-Escobar¹,

Ramírez-Quesada²,

Calle-Rodas³

et al. 2020

WJH

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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.

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Section: Discussionmentioning

confidence: 99%

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

Pérez-Escobar¹,

Ramírez-Quesada²,

Calle-Rodas³

et al. 2020

WJH

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“…[ 13 ] In the present case, R. ornithinolytica was detected in the puncture fluid of the liver abscess and is considered to be a pathogenic bacterium of the liver abscess. The most common GFPLA bacterial species is Klebsiella pneumoniae , followed by Escherichia coli , Streptococcus spp., and Clostridium perfringens [ 14 , 15 ] ; however, only one case of R. ornithinolytica has been reported [ 16 ] which is extremely rare. R. ornithinolytica is a capsulated Gram-negative rod that belongs to the Enterobacteriaceae family and is closely related to Klebsiella spp.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Rationale: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC.Patient concerns: A 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital.Diagnosis: Abdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess.Interventions: Percutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed.Outcomes: Despite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient's respiratory condition and renal function gradually worsened; The patient's general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37.Lessons: We report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC.

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“…Research has shown that hemoglobin was one of the independent prognostic factors of PLA ( 37 ). Furthermore, several studies have explored the effect of gas formation on PLA ( 38 , 39 ) and gas formation of abscess was comparative between the two groups in our study. In addition, we found that the abscess diameter of the patients in the low-AGR group was significantly larger than that in the high-AGR group.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Serum Albumin/Globulin Ratio in Patients With Pyogenic Liver Abscess

et al. 2021

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Pyogenic liver abscess (PLA) remains a significant challenge for modern clinicians. Serum albumin/globulin ratio (AGR) can reflect the progress of many diseases. However, the clinical significance of AGR in PLA has not been evaluated. The aim of this study was to explore the effect of AGR on the clinical characteristic and prognosis in PLA patients. This retrospective study included 392 PLA patients who admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January, 2007 to December, 2016. The medical records on admission were collected. Compared with the healthy controls and the patients with extraperitoneal infection or non-infectious liver disease, PLA patients had lower levels of AGR. The mean level of AGR in PLA patients was 1.02 ± 0.25. There were 179 (45.4%) patients with AGR > 1.02 and 213 (54.6%) patients with AGR ≤ 1.02. The baseline data and treatment plans of PLA patients with high or low AGR were comparative. However, PLA patients with a low AGR had higher body temperature, leukocytes and neutrophils, lower hemoglobin, poorer liver and coagulation function, larger abscess diameter, higher positive rate of pus culture and proportion of Escherichia coli, and were more susceptible to multiple bacteria. Moreover, PLA patients with a low AGR had more complications, including systemic inflammatory response syndrome (SIRS), peritoneal effusion and pleural effusion. And it also needs longer time for temperature normalization and hospital stay. In conclusion, PLA patients have lower AGR and lower AGR is associated with worse clinical manifestations, more complications and poorer prognosis. Thus, monitoring of AGR is of great clinical significance for evaluating the progress of PLA patients.

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Outcomes of Gas-Forming Pyogenic Liver Abscess Are Comparable to Non-Gas-Forming Pyogenic Liver Abscess in the Era of Multi-Modal Care: A Propensity Score Matched Study

Cited by 13 publications

References 28 publications

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

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

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

Clinical Significance of Serum Albumin/Globulin Ratio in Patients With Pyogenic Liver Abscess

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