Risk of infections subsequent to pyogenic liver abscess: a nationwide population-based study

Abstract

This nationwide study aimed to provide risk estimates for a panel of infections subsequent to pyogenic liver abscesses (PLA) in Taiwan. In this study, we selected 12 050 patients diagnosed with PLA as our study cohort and 60 250 non-PLA patients as our comparison cohort. We individually tracked each subject for a 1-year period beginning with their index date to identify those who were subsequently diagnosed with any of the following infections: pneumonia, endophthalmitis, septic pulmonary embolism, pulmonary abscess, pleural empyema, meningitis, abscess of prostate, renal and perinephric abscess, epidural spinal abscess, osteomyelitis, necrotizing fasciitis, splenic abscess, psoas abscess and infectious endocarditis. We found that during the 1-year follow-up period, the subjects with PLA had a consistently higher incidence of all types of infections than comparison subjects. In particular, compared with subjects without PLA, the adjusted hazard ratios (HR) of pulmonary abscess, pleural empyema, renal and perinephric abscess, epidural spinal abscess and splenic abscess were 26.71, 18.56, 43.21, 51.32 and 126.51, respectively. We further analysed the HR of extra-hepatic Klebsiella pneumoniae infections among patients with PLA caused by K. pneumoniae. We found that the HR was higher for 12 of the 15 analysed extra-hepatic infections after restricting the analysis to only infections with K. pneumoniae aetiologies.

Klebsiella pneumonia-induced prostate abscess: How to work it up?

“…Before the 1980s, the organism most commonly isolated from liver abscesses was Escherichia coli, but in Taiwan and Korea there has been a shift to KP, which is now highly endemic and the major cause of community-acquired pyogenic infections. [9][10][11][12][13] Pope and colleagues reported that a similar etiological shift, like one seen in our cases, is now occurring in the United States. 21 About 28% of patients with pyogenic liver abscess due to KP also suffer from metastatic complications, and the prostate can be involved.…”

“…21 About 28% of patients with pyogenic liver abscess due to KP also suffer from metastatic complications, and the prostate can be involved. 13 It is logical to postulate that the prostate was not the primary site, but secondary to the pyogenic liver abscess with KP in our cases. Authors hypothesized that primary pyogenic liver abscess with KP, although rare, is more common that primary prostate abscess with KP.…”

“…12 About 28% of patients with pyogenic liver abscess arising from KP suffered from hematogenous spread complications; hematogenous spreading prostate abscess was reported in 11/9839 KP-induced pyogenic liver abscesses. 13 Also, KP has been the leading causative microorganism of emphysematous prostatic abscess, which is the lethal form of prostatic abscess.…”

Pyogenic Liver Abscess is Associated With Increased Risk of Acute Kidney Injury

“…32,33 These studies have demonstrated that sepsis may affect kidney cells by the generation of inflammatory mediators, such as cytokines. Finally, 73% to 87.9% of all PLA patients were infected by Klebsiella pneumonia alone in Taiwan, 12,34 and PLA patients infected with K. pneumoniae were more prone to experiencing extrahepatic complications and metastasis than those with other types of PLA. 12,35 PLA-associated extrahepatic metastasis could exacerbate kidney injury caused by sepsis.…”

“…The overall mortality rates of PLA remain high, ranging from 2.5% to 19%, 2–4,6,7 and the mortality rate in Taiwan is approximately 8.3%. 8 Recently, PLA has been associated with an increased risk of malignancy, 9–11 subsequent infections, 12–15 acute pancreatitis, 16 and stroke. 17 However, the relationship between PLA and the risk of acute kidney injury (AKI) remains unclear.…”