Pyogenic liver abscess: Differences in etiology and treatment in Southeast Asia and Central Europe

Abstract

Knowledge of etiology and timely treatment of underlying causes, when possible, play an important role in the successful therapy of patients with pyogenic liver abscess (PLA). Recent publications from Central Europe and Southeast Asia hint at considerable differences in etiology. In this article, we aim to elaborate these differences and their therapeutic implications. Apart from some special types of PLA that are comparable in Southeast Asia and Central Europe (such as posttraumatic or postprocedural PLA), there are clear differences in the microbiological spectrum, which implies different risk factors and disease courses. Klebsiella pneumoniae (K. pneumoniae) PLA is predominantly seen in Southeast Asia, whereas, in Central Europe, PLA is typically caused by Escherichia coli, Streptococcus or Staphylococcus, and these patients are more likely to be older and to have a biliary abnormality or malignancy. K. pneumoniae patients are more likely to have diabetes mellitus. Control of septic spread is crucial in K. pneumoniae patients, whereas treatment of the underlying diseases is decisive in many Central European PLA patients.

Impact of advanced age on inpatients with pyogenic liver abscess in Taiwan: A nationwide claim-based analysis

“…For instance, the pathogenic distribution of PLA is subtly different between Asia and Europe. 1 The role of co-morbid diabetes mellitus in PLA has interesting controversies, as discovered by studies around the world. 2e4 Present evidence indicates a noticeable prevalence of PLA among the population in eastern Asia.…”

Case report: Real-time contrast-enhanced ultrasonography for the diagnosis of typical ‘bull's eye’ sign of hepatic abscess caused by Acinetobacter baumannii in a tumor patient

“…In addition, anaerobion infection may occur, so anti-anaerobic agents should be applied regularly. Treatment for E. histolytica may be conducted as follows: Drugs to eliminate E. histolytica in the inner organs are commonly used, assisted by radical treatment drugs for the treatment of intestinal amebiasis (3,14). Currently, metronidazole is the preferred antibiotic agent.…”

Resection of a methicillin-resistant Staphylococcus aureus liver abscess in a patient with Crohn’s disease under infliximab treatment: a case report

“…The image-guided percutaneous technique is a standard treatment of drainage [7]. Nevertheless, there remains a role for open or laparoscopic surgical intervention in the management of PLA with the documented indication as follows: no clinical response after four to seven days of percutaneous drainage; multiple, large, or loculated abscess; thick-walled abscess with viscous pus; and concomitant intra-abdominal surgical pathology [5,16,18,19]. Some authors have reported the efficacy and safety of emergent surgical drainage or resection [9,10,14,20,21].…”