Unique characteristics of pyogenic liver abscesses of biliary origin

Shi, Shaohua; Xia, Weiliang; Guo, Huimin; Kong, Haishen; Zheng, Shusen

doi:10.1016/j.surg.2015.11.012

Cited by 21 publications

(88 citation statements)

References 43 publications

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“…This study population consisted of PLA patients presenting between January 2008 and December 2015 to the first tertiary‐care affiliated hospital of Zhejiang University, a 2500‐bed referral centre for hepatopancreatobiliary diseases. These PLA patients met ≥1 of the following criteria: (i) pus obtained by aspiration or drainage of ≥1 intrahepatic abscesses; (ii) ≥1 liver abscesses found at operation and (iii) ≥1 hepatic inflammatory lesions with no completely necrotic liquefied focus or with ≥1 small abscesses demonstrated by imaging in conjunction with the presence of symptoms and signs of infection; these lesions were associated with recovery of appropriate microorganisms from blood and/or pus cultures or a pathologically acute inflammatory focus noted on liver biopsy, and the lesion(s) resolved with antibacterial administration. Those PLA patients with culture‐confirmed ESBL‐producing bacteria were chosen to be case group, and vice versa as control group.…”

Section: Methodsmentioning

confidence: 99%

“…The PLA aetiologies were divided into four categories based on the route of presumed infection: (i) biliary origin in patients with cholecystitis or cholangitis caused by any form of biliary disorder, (ii) haematogenous route via portal vein from an infectious focus documented in the portal venous area, (iii) documented bacteremic episodes anteceded by PLA and (iv) cryptogenic abscess in which no source of infection could be identified. Pertinent comorbidities included diabetes, cirrhosis, immunosuppression and a treatment history of malignancy such as operation and/or chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Nowadays pyogenic liver abscess (PLA) remains a major infectious disease in the hepatobiliary system in Southeast Asia, with a rising incidence from 11 to 18 cases per 100 000 population between 1998 and 2004 in Taiwan, and accounting for 86 to 160 cases per 100 000 hospital admissions each year in Singapore and in China mainland . As for PLA aetiologies in Southeast Asian, 50%‐70% of PLA cases are cryptogenic in origin, and 11%‐37% have underlying biliary pathology . Of PLA related to biliary origin, extra‐ and intrahepatic cholangiolithiasis, and abnormal bilioenteric communication including hepaticojejunostomy and indwelling biliary stents as one form of operation performed for hepatopancreatobiliary tumours, are closely associated with recurrent attacks of cholangitis and biliary sepsis, which can lead to the emergence of multidrug resistant (MDR) bacteria after the repeated administration of broad‐spectrum antibiotics .…”

Section: Introductionmentioning

confidence: 99%

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Biliary diseases as main causes of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae

Shi

Feng

Lai

et al. 2016

Liver International

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Background & Aims Little is known about aetiology and morbidity and clinical characteristics of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Methods An analysis between pyogenic liver abscess patients caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates and those caused by non‐extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae was performed. Results Among 817 pyogenic liver abscess patients, there were 176 patients (21.5%) with pyogenic liver abscess of biliary origin, and 67 pyogenic liver abscess patients (8.2%) caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates (mainly Escherichia coli and Klebsiella pneumoniae). Of 176 pyogenic liver abscess patients related to biliary disorders, there were 48 pyogenic liver abscess patients (27.3%) caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Within 67 pyogenic liver abscess patients caused by Enterobacteriaceae expressing extended‐spectrum beta‐lactamases, the occurrences of 48 pyogenic liver abscess patients (71.6%) were associated with biliary disorders. When compared with pyogenic liver abscess patients caused by non‐extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae, there were significantly greater incidences of polymicrobial infections, bacteremia, pulmonary infection, recurrence and death in pyogenic liver abscess patients caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Carbapenems remain mainstay drugs against extended‐spectrum beta‐lactamase‐producing E. coli and K. pneumoniae. Independent risk factors for occurrence of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae were biliary disorders including extra‐ and intrahepatic cholangiolithiasis and an abnormal bilioenteric communication between bile and gut, a treatment history of malignancy such as operation and chemotherapy, pulmonary infection, and diabetes mellitus. Conclusions Pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates mainly occurs in patients with biliary disorders or with a treatment history of malignancy. The mainstay of treatment remains carbapenems in combination with adequate aspiration or drainage.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Biliary diseases as main causes of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae

Shi

Feng

Lai

et al. 2016

Liver International

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show abstract

“…Less frequently, single or multiple liver abscesses develop, especially in patients with persistent obstruction [51]. These are being documented with increasing frequency due to improved imaging techniques.…”

Section: Specific Syndromes/sites Of Infectionmentioning

confidence: 99%

Infections in Cancer Patients with Solid Tumors: A Review

2017

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Solid tumors are much more common than hematologic malignancies. Although severe and prolonged neutropenia is uncommon, several factors increase the risk of infection in patients with solid tumors, and the presence of multiple risk factors in the same patient is not uncommon. These include obstruction (most often caused by progression of the tumor), disruption of natural anatomic barriers such as the skin and mucosal surfaces, and treatment-related factors such as chemotherapy, radiation, diagnostic and/or therapeutic surgical procedures, and the increasing use of medical devices such as various catheters, stents, and prostheses. Common sites of infection include the skin and skin structures (including surgical site infections), the bloodstream (including infections associated with central venous catheters), the lungs, the hepato-biliary and intestinal tracts, and the urinary tract, and include distinct clinical syndromes such as post-obstructive pneumonia, obstructive uropathy, and neutropenic enterocolitis. The epidemiology of most of these infections is changing with resistant organisms [MRSA, Pseudomonas aeruginosa, extended spectrum beta-lactamase (ESBL)-producing organisms] being isolated more often than in the past. Polymicrobial infections now predominate when deep tissue sites are involved. Conservative management of most of these infections (antibiotics, fluid and electrolyte replacement, bowel rest when needed) is generally effective, with surgical intervention being reserved for the drainage of deep abscesses, or to deal with complications such as intestinal obstruction or hemorrhage. Infected prostheses often need to be removed. Reactivation of certain viral infections (HBV, HCV, and occasionally CMV) has become an important issue, and screening, prevention and treatment strategies are being developed. Infection prevention, infection control, and antimicrobial stewardship are important strategies in the overall management of infections in patients with solid tumors. Occasionally, infections mimic solid tumors and cause diagnostic and therapeutic challenges.

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

Alonso¹,

Vega²,

Marcacuzco³

et al. 2023

Langenbecks Arch Surg

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Background Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST. Methods We reviewed the medical charts of all of our institution’s adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST ( n = 41 patients) and non-ST ( n = 255). A comparison between groups was performed. Results The overall median age was 68 years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10 days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group ( p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST ( p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10 days on presentation comprised the risk factors that indicated the need to perform ST. Conclusions There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10 days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD.

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Unique characteristics of pyogenic liver abscesses of biliary origin

Cited by 21 publications

References 43 publications

Biliary diseases as main causes of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae

Biliary diseases as main causes of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae

Infections in Cancer Patients with Solid Tumors: A Review

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

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