Microbiology of Liver Abscesses and Its Correlation with Hospital Stay

Marcelo Jose Costa; Nuno Dias Machado; Joao Pinto-de-Sousa; Teresa Monica Rocha; Carlos Soares

doi:doi:10.11648/j.js.20210906.14

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Microbiology of Liver Abscesses and Its Correlation with Hospital Stay

Marcelo Jose Costa, Nuno Dias Machado, Joao Pinto-de-Sousa, Teresa Monica Rocha, Carlos Soares

Published in Journal of Surgery (Volume 9, Issue 6)

Received: 28 October 2021 Accepted: 23 November 2021 Published: 2 December 2021

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Abstract

Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with prognosis and length of hospital stay. The aim of this study was to characterize the main microbiological agents involved in LA in a European hospital, to assess resistance patterns and to relate them to patient prognosis and length of hospital stay. A retrospective analysis was conducted on all LA-diagnosed adult patients, admitted to a northern Portuguese hospital between 2013 and 2018. Clinical, laboratory, imaging, and microbiological data were collected for descriptive and statistical analysis. A total of 63 LA diagnosed patients were admitted to the General Surgery Unit between January 2013 and December 2018. Patients´ mean age at diagnosis was 71.4 years. Abdominal pain and fever were the most common symptoms on admission (73.0 and 61.9%, respectively). Fifty-eight percent of patients were female. Leukocytosis and increased C-reactive protein were the most observed analytical changes. The most frequently isolated microbiological agents were Escherichia coli (36.5%), Streptococcus species (27.8%), Klebsiella pneumoniae (11.4%), and anaerobic agents (10.1%). Of the isolated species, 12.5% proved multi-resistant. A higher LA frequency caused by Klebsiella pneumoniae was identified in relation to other Western series. Klebsiella pneumoniae was associated with a longer hospital stay (25.67 vs 16.50 days, p=0.07) when compared to other agents. There were 4 mortality cases in our series (6.3%). Microbiological agents, namely Klebsiella pneumoniae and multidrug-resistant agents have a predominant role in LA management, negatively affecting prognosis and length of hospital stay. Despite advances in LA treatment, more studies are required to determine the appropriate therapy owing to the absence of internationally defined guidelines. Our results provide important information for the proper management of these patients.

Published in	Journal of Surgery (Volume 9, Issue 6)
DOI	10.11648/j.js.20210906.14
Page(s)	271-276
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Liver Abscess, Pyogenic Liver Abscess (PLA), Microbiology

References

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[2]	Shankar A, Srinivas S, Kalyanasundaram S. Turquoise sign: pyogenic liver abscess. Abdom Radiol (NY). 2020 Jan; 45 (1): 232-233.
[3]	Feng-Chiao Tsai, Yu-Tsung Huang, Luan-Yin Chang, Jin-Town Wang, Pyogenic Liver Abscess as Endemic Disease, Emerg Infect Dis. 2008 Oct; 14 (10): 1592–1600.
[4]	Foo NP, Chen KT, Lin HJ, Guo HR., Characteristics of pyogenic liver abscess patients with and without diabetes mellitus, Am J Gastroenterol. 2010 Feb; 105 (2): 328-35.
[5]	Shaohua S, Weiliang X, Haijun G, Haishen K, Shusen Z., Unique characteristics of pyogenic liver abscesses of biliary origin, Surgery. 2016 May; 159 (5): 1316-24.
[6]	Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis 2004 Dec 1; 39 (11): 1654-9.
[7]	Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY, Klebsiella pneumoniae liver abscess: a new invasive syndrome, Lancet Infect Dis. 2012 Nov; 12 (11): 881-7.
[8]	Zhang S, Zhang X, Wu Q, Zheng X, Dong G, Fang R, Zhang Y, Cao J, Zhou T. Clinical, microbiological, and molecular epidemiological characteristics of Klebsiella pneumoniae-induced pyogenic liver abscess in southeastern China. Antimicrob Resist Infect Control. 2019 Oct 29; 8: 166.
[9]	Lübbert C, Wiegand J, Karlas T, Therapy of Liver Abscesses Viszeralmedizin. 2014 Oct; 30 (5): 334–341.
[10]	Marianna G. Mavilia, Marco Molina, George Y. Wu, The Evolving Nature of Liver Abscess: A Review, J Clin Transl Hepatol. 2016 Jun 28; 4 (2): 158–168.
[11]	Serraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A, Melchio R, Fenoglio LM., Characteristics and management of pyogenic liver abscess: A European experience, Medicine (Baltimore). 2018 May; 97 (19): e0628.
[12]	Neill L, Edwards F, Collin SM, Harrington D, Wakerley D, Rao GG, McGregor AC., Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess. 2020 Sep 22; 58 (10): e01153-20.
[13]	Petri A, Hohn J, Hódi Z, Wolfárd A, Balogh A., Pyogenic liver abscess – 20 years’ experience. Comparison of results of treatment in two periods. Langenbecks Arch Surg. 2002 Apr; 387 (1): 27-31.
[14]	Chen SC, Huang C, Tsai SJ, Yen CH, Lin DB, Wang PH, Chen CC, Lee MC. Severity of disease as main predictor for mortality in patients with pyogenic liver abscess. Am J Surg. 2009 Aug; 198 (2): 164-72.
[15]	Alvarez Pérez JA, González JJ, Baldonedo RF, Sanz L, Carreño G, Junco A, Rodríguez JI, Martínez MD, Jorge JI, Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess, Am J Surg. 2001 Feb; 181 (2): 177-86.
[16]	Tan YM, Chung AY, Chow PK, Cheow PC, Wong WK, Ooi LL, Soo KC, An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5, Ann Surg. 2005 Mar; 241 (3): 485-90.
[17]	Roediger R, Lisker-Melman M. Pyogenic and Amebic Infections of the Liver. Gastroenterol Clin North Am. 2020 Jun; 49 (2): 361-377.
[18]	Akhondi H, Sabih DE. Liver Abscess. 2021 Jul 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
[19]	Pang TC, Fung T, Samra J, Hugh TJ, Smith RC, Pyogenic liver abscess: an audit of 10 years' experience, World J Gastroenterol. 2011 Mar 28; 17 (12): 1622-30.

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APA Style

Marcelo Jose Costa, Nuno Dias Machado, Joao Pinto-de-Sousa, Teresa Monica Rocha, Carlos Soares. (2021). Microbiology of Liver Abscesses and Its Correlation with Hospital Stay. Journal of Surgery, 9(6), 271-276. https://doi.org/10.11648/j.js.20210906.14

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ACS Style

Marcelo Jose Costa; Nuno Dias Machado; Joao Pinto-de-Sousa; Teresa Monica Rocha; Carlos Soares. Microbiology of Liver Abscesses and Its Correlation with Hospital Stay. J. Surg. 2021, 9(6), 271-276. doi: 10.11648/j.js.20210906.14

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AMA Style

Marcelo Jose Costa, Nuno Dias Machado, Joao Pinto-de-Sousa, Teresa Monica Rocha, Carlos Soares. Microbiology of Liver Abscesses and Its Correlation with Hospital Stay. J Surg. 2021;9(6):271-276. doi: 10.11648/j.js.20210906.14

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@article{10.11648/j.js.20210906.14,
  author = {Marcelo Jose Costa and Nuno Dias Machado and Joao Pinto-de-Sousa and Teresa Monica Rocha and Carlos Soares},
  title = {Microbiology of Liver Abscesses and Its Correlation with Hospital Stay},
  journal = {Journal of Surgery},
  volume = {9},
  number = {6},
  pages = {271-276},
  doi = {10.11648/j.js.20210906.14},
  url = {https://doi.org/10.11648/j.js.20210906.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210906.14},
  abstract = {Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with prognosis and length of hospital stay. The aim of this study was to characterize the main microbiological agents involved in LA in a European hospital, to assess resistance patterns and to relate them to patient prognosis and length of hospital stay. A retrospective analysis was conducted on all LA-diagnosed adult patients, admitted to a northern Portuguese hospital between 2013 and 2018. Clinical, laboratory, imaging, and microbiological data were collected for descriptive and statistical analysis. A total of 63 LA diagnosed patients were admitted to the General Surgery Unit between January 2013 and December 2018. Patients´ mean age at diagnosis was 71.4 years. Abdominal pain and fever were the most common symptoms on admission (73.0 and 61.9%, respectively). Fifty-eight percent of patients were female. Leukocytosis and increased C-reactive protein were the most observed analytical changes. The most frequently isolated microbiological agents were Escherichia coli (36.5%), Streptococcus species (27.8%), Klebsiella pneumoniae (11.4%), and anaerobic agents (10.1%). Of the isolated species, 12.5% proved multi-resistant. A higher LA frequency caused by Klebsiella pneumoniae was identified in relation to other Western series. Klebsiella pneumoniae was associated with a longer hospital stay (25.67 vs 16.50 days, p=0.07) when compared to other agents. There were 4 mortality cases in our series (6.3%). Microbiological agents, namely Klebsiella pneumoniae and multidrug-resistant agents have a predominant role in LA management, negatively affecting prognosis and length of hospital stay. Despite advances in LA treatment, more studies are required to determine the appropriate therapy owing to the absence of internationally defined guidelines. Our results provide important information for the proper management of these patients.},
 year = {2021}
}

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TY - JOUR
T1 - Microbiology of Liver Abscesses and Its Correlation with Hospital Stay
AU - Marcelo Jose Costa
AU - Nuno Dias Machado
AU - Joao Pinto-de-Sousa
AU - Teresa Monica Rocha
AU - Carlos Soares
Y1 - 2021/12/02
PY - 2021
N1 - https://doi.org/10.11648/j.js.20210906.14
DO - 10.11648/j.js.20210906.14
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 271
EP - 276
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20210906.14
AB - Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with prognosis and length of hospital stay. The aim of this study was to characterize the main microbiological agents involved in LA in a European hospital, to assess resistance patterns and to relate them to patient prognosis and length of hospital stay. A retrospective analysis was conducted on all LA-diagnosed adult patients, admitted to a northern Portuguese hospital between 2013 and 2018. Clinical, laboratory, imaging, and microbiological data were collected for descriptive and statistical analysis. A total of 63 LA diagnosed patients were admitted to the General Surgery Unit between January 2013 and December 2018. Patients´ mean age at diagnosis was 71.4 years. Abdominal pain and fever were the most common symptoms on admission (73.0 and 61.9%, respectively). Fifty-eight percent of patients were female. Leukocytosis and increased C-reactive protein were the most observed analytical changes. The most frequently isolated microbiological agents were Escherichia coli (36.5%), Streptococcus species (27.8%), Klebsiella pneumoniae (11.4%), and anaerobic agents (10.1%). Of the isolated species, 12.5% proved multi-resistant. A higher LA frequency caused by Klebsiella pneumoniae was identified in relation to other Western series. Klebsiella pneumoniae was associated with a longer hospital stay (25.67 vs 16.50 days, p=0.07) when compared to other agents. There were 4 mortality cases in our series (6.3%). Microbiological agents, namely Klebsiella pneumoniae and multidrug-resistant agents have a predominant role in LA management, negatively affecting prognosis and length of hospital stay. Despite advances in LA treatment, more studies are required to determine the appropriate therapy owing to the absence of internationally defined guidelines. Our results provide important information for the proper management of these patients.
VL - 9
IS - 6
ER -

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Author Information

Marcelo Jose Costa

General Surgery Unit, Centro Hospitalar do Tamega e Sousa, Penafiel, Portugal
Nuno Dias Machado

General Surgery Unit, Centro Hospitalar do Tamega e Sousa, Penafiel, Portugal
Joao Pinto-de-Sousa

General Surgery Unit, Centro Hospitalar de Trás-os-montes e Alto Douro, Vila Real, Portugal
Teresa Monica Rocha

General Surgery Unit, Centro Hospitalar do Tamega e Sousa, Penafiel, Portugal
Carlos Soares

General Surgery Unit, Centro Hospitalar do Tamega e Sousa, Penafiel, Portugal

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APA Style

Marcelo Jose Costa, Nuno Dias Machado, Joao Pinto-de-Sousa, Teresa Monica Rocha, Carlos Soares. (2021). Microbiology of Liver Abscesses and Its Correlation with Hospital Stay. Journal of Surgery, 9(6), 271-276. https://doi.org/10.11648/j.js.20210906.14

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ACS Style

Marcelo Jose Costa; Nuno Dias Machado; Joao Pinto-de-Sousa; Teresa Monica Rocha; Carlos Soares. Microbiology of Liver Abscesses and Its Correlation with Hospital Stay. J. Surg. 2021, 9(6), 271-276. doi: 10.11648/j.js.20210906.14

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AMA Style

Marcelo Jose Costa, Nuno Dias Machado, Joao Pinto-de-Sousa, Teresa Monica Rocha, Carlos Soares. Microbiology of Liver Abscesses and Its Correlation with Hospital Stay. J Surg. 2021;9(6):271-276. doi: 10.11648/j.js.20210906.14

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@article{10.11648/j.js.20210906.14,
  author = {Marcelo Jose Costa and Nuno Dias Machado and Joao Pinto-de-Sousa and Teresa Monica Rocha and Carlos Soares},
  title = {Microbiology of Liver Abscesses and Its Correlation with Hospital Stay},
  journal = {Journal of Surgery},
  volume = {9},
  number = {6},
  pages = {271-276},
  doi = {10.11648/j.js.20210906.14},
  url = {https://doi.org/10.11648/j.js.20210906.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210906.14},
  abstract = {Pyogenic liver abscess (LA) is a rare disease associated with high morbidity and mortality rates, and prolonged hospital stay. Certain microbiological agents have assumed a predominant role in Asian series, however, few studies have been published in Europe regarding the microbiological agents involved in liver abscesses and their relationship with prognosis and length of hospital stay. The aim of this study was to characterize the main microbiological agents involved in LA in a European hospital, to assess resistance patterns and to relate them to patient prognosis and length of hospital stay. A retrospective analysis was conducted on all LA-diagnosed adult patients, admitted to a northern Portuguese hospital between 2013 and 2018. Clinical, laboratory, imaging, and microbiological data were collected for descriptive and statistical analysis. A total of 63 LA diagnosed patients were admitted to the General Surgery Unit between January 2013 and December 2018. Patients´ mean age at diagnosis was 71.4 years. Abdominal pain and fever were the most common symptoms on admission (73.0 and 61.9%, respectively). Fifty-eight percent of patients were female. Leukocytosis and increased C-reactive protein were the most observed analytical changes. The most frequently isolated microbiological agents were Escherichia coli (36.5%), Streptococcus species (27.8%), Klebsiella pneumoniae (11.4%), and anaerobic agents (10.1%). Of the isolated species, 12.5% proved multi-resistant. A higher LA frequency caused by Klebsiella pneumoniae was identified in relation to other Western series. Klebsiella pneumoniae was associated with a longer hospital stay (25.67 vs 16.50 days, p=0.07) when compared to other agents. There were 4 mortality cases in our series (6.3%). Microbiological agents, namely Klebsiella pneumoniae and multidrug-resistant agents have a predominant role in LA management, negatively affecting prognosis and length of hospital stay. Despite advances in LA treatment, more studies are required to determine the appropriate therapy owing to the absence of internationally defined guidelines. Our results provide important information for the proper management of these patients.},
 year = {2021}
}

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