OBJECTIVES: Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment. METHODS: We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality. RESULTS: All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02). CONCLUSION: The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.
OBJECTIVES: Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment. METHODS: We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality. RESULTS: All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02). CONCLUSION: The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.
Authors: Matías E Czerwonko; Pablo Huespe; Santiago Bertone; Pablo Pellegrini; Oscar Mazza; Juan Pekolj; Eduardo de Santibañes; Sung Ho Hyon; Martín de Santibañes Journal: HPB (Oxford) Date: 2016-10-03 Impact factor: 3.647
Authors: Vishal G Shelat; Clement L K Chia; Charleen S W Yeo; Wang Qiao; Winston Woon; Sameer P Junnarkar Journal: World J Surg Date: 2015-10 Impact factor: 3.352