Pyogenic liver abscesses due to Escherichia coli are still related to worse outcomes
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 abscess...
Saved in:
Published in | Irish journal of medical science Vol. 189; no. 1; pp. 155 - 161 |
---|---|
Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
London
Springer London
01.02.2020
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | 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. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0021-1265 1863-4362 |
DOI: | 10.1007/s11845-019-02041-4 |