Jose Juan Ruiz-Hernández1,2, Alicia Conde-Martel3,4, Miriam Serrano-Fuentes1, Marta Hernández-Meneses1, Alejandro Merlán-Hermida1, Alba Rodríguez-Pérez1, Joaquín Marchena-Gómez2,5. 1. Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain. 2. Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain. 3. Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain. alicia.conde@ulpgc.es. 4. Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain. alicia.conde@ulpgc.es. 5. Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain.
Abstract
BACKGROUND: In western countries, there has been a gradual shift from Escherichia coli to Klebsiella pneumoniae as an emerging pathogen isolated from pyogenic liver abscesses (PLA). AIMS: To compare outcomes between patients with Escherichia coli liver abscesses and non-Escherichia coli liver abscesses in terms of mortality. METHODS: One hundred nine-three consecutive hospital admissions of Pyogenic liver abscesses were analyzed, mean age 66.9 years old (± 13.6), 112 men (58%). The sample was divided into two groups: E. coli liver abscesses and non-E. coli liver abscesses. The etiologic, clinical, and microbiologic characteristics; therapeutic options; and outcomes, in terms of morbidity and mortality, between E. coli and non-E. coli liver abscesses were compared. In-hospital mortality, as outcome variable, was analyzed in a multivariate analysis. RESULTS: Fifty-seven episodes of PLA (29.5%) corresponded to E. coli infections, and 136 (70.5%) to non-E. coli infections. Patients with E. coli PLA were more likely to have jaundice, polymicrobial isolation (57.1% vs 21.6%, p < 0.001), biliary origin (71.9% vs 39%, p < 0.001), and septic shock (38.6% vs 12.5%, p < 0.001). Antibiotic therapy alone, without percutaneous drainage, was less common in the E. coli PLA group (5.3% vs 18.4%, p = 0.018). These patients also showed a higher mortality (28.1% vs 11%, p = 0.003). In multivariate analysis, E. coli isolation PLA adjusted remained as an independent factor of mortality (OR 2.6, 95%CI 1.04-6.56, p = 0.041). CONCLUSIONS: E. coli liver abscess may preclude a worse outcome than other microbiological agents, including the development of septic shock and mortality. Aggressive management must be considered.
BACKGROUND: In western countries, there has been a gradual shift from Escherichia coli to Klebsiella pneumoniae as an emerging pathogen isolated from pyogenic liver abscesses (PLA). AIMS: To compare outcomes between patients with Escherichia coli liver abscesses and non-Escherichia coli liver abscesses in terms of mortality. METHODS: One hundred nine-three consecutive hospital admissions of Pyogenic liver abscesses were analyzed, mean age 66.9 years old (± 13.6), 112 men (58%). The sample was divided into two groups: E. coli liver abscesses and non-E. coli liver abscesses. The etiologic, clinical, and microbiologic characteristics; therapeutic options; and outcomes, in terms of morbidity and mortality, between E. coli and non-E. coli liver abscesses were compared. In-hospital mortality, as outcome variable, was analyzed in a multivariate analysis. RESULTS: Fifty-seven episodes of PLA (29.5%) corresponded to E. coli infections, and 136 (70.5%) to non-E. coli infections. Patients with E. coli PLA were more likely to have jaundice, polymicrobial isolation (57.1% vs 21.6%, p < 0.001), biliary origin (71.9% vs 39%, p < 0.001), and septic shock (38.6% vs 12.5%, p < 0.001). Antibiotic therapy alone, without percutaneous drainage, was less common in the E. coli PLA group (5.3% vs 18.4%, p = 0.018). These patients also showed a higher mortality (28.1% vs 11%, p = 0.003). In multivariate analysis, E. coli isolation PLA adjusted remained as an independent factor of mortality (OR 2.6, 95%CI 1.04-6.56, p = 0.041). CONCLUSIONS: E. coli liver abscess may preclude a worse outcome than other microbiological agents, including the development of septic shock and mortality. Aggressive management must be considered.
Authors: H Cerwenka; H Bacher; G Werkgartner; A El-Shabrawi; P Kornprat; G A Bernhardt; H J Mischinger Journal: Chemotherapy Date: 2005-10-14 Impact factor: 2.544
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