Clinical Characteristics of Pyogenic Liver Abscess; Focus ing on Comparison of Primary Pathogens between Esch erichia coli and Klebsiella pneumonia = Clinical Characteristics of Pyogenic Liver Abscess; Focus ing on Comparison of Primary Pathogens between Esch erichia coli and Klebsiella pneumonia

다국어 초록 (Multilingual Abstract)

Aims: Pyogenic liver abscess (PLA) is a common intra-abdominal infection in adults. However, the clinical influence of primary pathogens of liver abscess on patients has not yet been fully elucidated. We aimed to investigate the clinical features of PLA patients according to the pathogens, such as, Escherichia coli (PLA-EC) or Klebsiella pneumoniae (PLA-KP).
Methods: A retrospective review was performed for consecutive 255 PLA patients who admitted to our institute from January 2007 to December 2017. Of these 255 patients, 100 patients were excluded due to definite pathogen (n=63) and the other pathogen rather than Escherichia. coli or Klebsiella pneumonia (n=37). Culture was defined as positive when pathogen was confirmed by blood or aspiration culture. The remaining 155 patients were enrolled in this study, and were dichotomized as two groups of PLA-EC (n=34, 21.9%) and PLA-KP (n=121, 78.1%).
Results: The mean age of PLA-EC patients was higher than that of PLA-KP patients (66.5±13.7 vs 60.2±13.2, P=0.016). Gastrointestinal cancer including stomach, liver, or biliary tract was more common in PLA-EC group than PLA-KP group (50.0 vs 18.2 %, P<0.001). Chronic alcoholics (0.0 vs 9.1 %, P=0.068) and diabetes (88.2 vs. 11.28 %, P=0.073) tended to be more frequent in PLA-KP group than PLA-EC group. Anemia (29.4 vs. 9.1 %, P=0.002) and hyperbilirubinemia (58.8 vs. 36.4 %, P=0.019) were found more frequently in PLA-EC than in PLA-KP. The abscess-related mortality in PLA-EC patients was significantly higher than that in PLA-KP patients (7/27, 20.6% vs. 7/114, 5.8%) (P=0.008).
Conclusions: Gastrointestinal cancer of stomach, liver, or biliary tract may be associated with PLA-EC. Therefore, these patients require work-up and careful managements, especially in PLA patients who are combined with anemia or jaundice.