Pyogenic Liver Abscess Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Nationwide, Population-Based Cohort Study

Abstract

Background: To date, no comprehensive epidemiological study exists on pyogenic liver abscess (PLA) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) worldwide.Methods: We conducted a retrospective cohort study by using data from Taiwan National Health Insurance Research Database (NHIRD) to examine the association between newly diagnosed T2DM and PLA. The T2DM cohort included patients newly diagnosed as having T2DM (ICD-9-CM:250) from 2000 to 2009, with follow-up until December 31, 2011. The comparison cohort was then recruited through 1:4 random frequency matching with the T2DM cohort. Finally, the adjusted hazard ratios for PLA were compared between the T2DM and comparison cohorts, which included 44,728 patients with T2DM and 178,912 patients without DM respectively.Results: In T2DM cohort, 166 patients were diagnosed as having PLA (incidence rate = 5.87 per 10,000 person-years) and in comparison cohort, 238 patients were diagnosed as having PLA (incidence rate = 2.06 per 10,000 person-years). The T2DM cohort exhibited higher PLA risk than did the comparison cohort (hazard ratio = 2.83, 95% confidence interval = 2.32–3.46). Furthermore, the adjusted hazard ratio for PLA risk in T2DM cohort was the highest in those who were younger, man and with duration of DM <2 years. In the T2DM cohort, the most common PLA causative agent was Klebsiella pneumonia (KP). In addition, PLA risk was high in T2DM patients with gallstone and cholecystitis. Compared with comparison cohort, patients with T2DM prescribed acarbose has a lower PLA risk, however glyburide significantly increased PLA risk in T2DM cohort.Conclusion: In patients with newly diagnosed T2DM, PLA risk was high and acarbose might reduce PLA risk.

Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses

“…All authors report Klebsiella pneumoniae and E. coli as the most common bacteria cultured in pus from PLA [ 1 , 24 , 27 , 28 , 31 , 34 ], with E. coli being more frequently associated with biliary diseases [ 1 , 23 , 31 ] and diabetes mellitus [ 35 , 36 ].…”

Pyogenic Liver Abscess Caused by Staphylococcus hominis: A Case Report

“…It has been estimated that the incidence of pyogenic liver abscess is higher in Asian countries, with approximately 12–18 patients per 100,000 population per year 10 . It has been reported that recently the incidence is increasing due to the application of interventional therapy in hepatobiliary diseases and the aggravation of multidrug resistance in microorganisms, and can further increase in patients with diabetes mellitus or in those receiving immunosuppressive therapy 11 . The natural course and clinical manifestations can vary depending on the pathogenic bacterium.…”

“…10 It has been reported that recently the incidence is increasing due to the application of interventional therapy in hepatobiliary diseases and the aggravation of multidrug resistance in microorganisms, and can further increase in patients with diabetes mellitus or in those receiving immunosuppressive therapy. 11 The natural course and clinical manifestations can vary depending on the pathogenic bacterium. Thus, the identification of the pathogens is of vital importance to clinical management.…”

GiantKlebsiella pneumoniaepyogenic liver abscess in the left liver lobe presenting with dyspepsia and vaginal discharge

“…Atypical symptoms can further arise in cases of a giant abscess (characteristically >10 cm) as it exerts anatomical compression onto surrounding structures and can rarely rupture into adjacent thoracic, pericardial and peritoneal cavities 8–10. Unusual presentations can also be driven by underlying risk factors such as diabetes mellitus, which is associated with a higher incidence of the increasingly dominant pathogen, Klebsiella pneumoniae 11–13. Surgical drainage is usually recommended for abscesses >5 cm 14.…”