Jan Kubovy1, Shwan Karim1, Steven Ding1. 1. Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Christchurch.
Abstract
AIMS: The determinants, management and outcomes of pyogenic liver abscess [PLA] are changing. We aimed to compare these in a New Zealand cohort. METHODS: We have retrospectively reviewed all PLA cases presenting to Christchurch Hospital over 12 months between 2014 and 2015. RESULTS: Twenty-five cases presented over this period. The incidence was 5/100,000. Eighty percent were Caucasian with overall 4:1 male preponderance. Commonest comorbidities were diabetes, hypertension, atrial fibrillation and immunosuppression. Underlying pancreatico-biliary disease featured in 20%, preceding Whipple's or hepatic resection in 24% and inflammatory bowel disease [IBD] in 12%. Commonest complication was septic shock with intensive care unit admission in four cases. The evident cause was recent Whipple's procedure or hepatic resection (24%), pancreatico-biliary (16%), diverticulitis (12%) and active IBD (8%). Cause remained cryptogenic in 28%. The commonest microorganism was Streptococcus intermedius. The management comprised of: antibiotics alone (n=6), needle aspiration (n=2), catheter drainage (n=14), biliary drainage (n=3), surgical drainage (n=2). These interventions were in accordance with current international recommendations. There were no deaths and the mean length of stay was 10.3 days. CONCLUSION: PLA continues to carry significant morbidity. Demographics, including ethnicity, play an important role. Our tertiary centre cohort may account for higher incidence and better clinical outcomes.
AIMS: The determinants, management and outcomes of pyogenic liver abscess [PLA] are changing. We aimed to compare these in a New Zealand cohort. METHODS: We have retrospectively reviewed all PLA cases presenting to Christchurch Hospital over 12 months between 2014 and 2015. RESULTS: Twenty-five cases presented over this period. The incidence was 5/100,000. Eighty percent were Caucasian with overall 4:1 male preponderance. Commonest comorbidities were diabetes, hypertension, atrial fibrillation and immunosuppression. Underlying pancreatico-biliary disease featured in 20%, preceding Whipple's or hepatic resection in 24% and inflammatory bowel disease [IBD] in 12%. Commonest complication was septic shock with intensive care unit admission in four cases. The evident cause was recent Whipple's procedure or hepatic resection (24%), pancreatico-biliary (16%), diverticulitis (12%) and active IBD (8%). Cause remained cryptogenic in 28%. The commonest microorganism was Streptococcus intermedius. The management comprised of: antibiotics alone (n=6), needle aspiration (n=2), catheter drainage (n=14), biliary drainage (n=3), surgical drainage (n=2). These interventions were in accordance with current international recommendations. There were no deaths and the mean length of stay was 10.3 days. CONCLUSION: PLA continues to carry significant morbidity. Demographics, including ethnicity, play an important role. Our tertiary centre cohort may account for higher incidence and better clinical outcomes.
Authors: Lisa Zimmermann; Sebastian Wendt; Christoph Lübbert; Thomas Karlas Journal: United European Gastroenterol J Date: 2021-07-30 Impact factor: 4.623