Molecular mechanism of Xuebijing in treating pyogenic liver abscess complicated with sepsis / 世界急诊医学杂志（英文）

@#BACKGROUND: Xuebijing (XBJ) can alleviate the inflammatory response, improve organ function, and shorten the intensive care unit (ICU) stay in patients with pyogenic liver abscess (PLA) complicated with sepsis, but the molecular mechanisms have not been elucidated. This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach. METHODS: The active ingredients and targets of XBJ were retrieved from the ETCM database. Potential targets related to PLA and sepsis were retrieved from the GeneCards, PharmGKB, DisGeNet, Online Mendelian Inheritance in Man (OMIM), Therapeutic Targets Database (TTD), and DrugBank databases. The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets. Protein-protein interaction networks were analyzed using the STRING database. Potential treatment targets were imported into the Metascape platform for Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Molecular docking was performed to validate the interactions between active ingredients and core targets. RESULTS: XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis. Interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor (TNF) were identified as core targets. KEGG enrichment analysis revealed important pathways, including the interleukin-17 (IL-17) signaling pathway, the TNF signaling pathway, the nuclear factor-kappa B (NF-κB) signaling pathway, and the Toll-like receptor (TLR) signaling pathway. Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets. CONCLUSION: XBJ may exert therapeutic effects on PLA complicated with sepsis by modulating signaling pathways, such as the IL-17, TNF, NF-κB, and TLR pathways, and targeting IL-1β, IL-6, and TNF.

Diagnostic approach of liver abscess

Liver abscess is an infection of parasitic or bacteria into the liver parenchyma which causes encapsulation of suppurative material surrounded by inflammatory tissue. Liver abscess is an important health problem especially in low-middle income countries. It is not easy to diagnose liver abscess due to non-specific clinical signs. This case report, we presenteda 46-year-old man who was hospitalized with suspected pulmonary infection. However, in the course of the patient's disease, we found a liver abscess.

Gas Under Right Hemidiaphragm: A Rare Presentation of Unruptured Liver Abscess

A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered.

Clinical features and etiological analysis of patients with pyogenic liver abscess and the application of mNGS in pyogenic liver abscess / 中华急诊医学杂志

Objective:To analyze the clinical features of patients with pyogenic liver abscess (PLA) and the application of mNGS in PLA, thus to provide reference for clinical diagnosis and treatment.Methods:The demographic and clinical data of 549 patients with liver abscess admitted to Zhongshan Hospital Affiliated to Fudan University from December 2015 to June 2020 were analyzed retrospectively. According to the detection of Klebsiella pneumoniae in 246 patients with positive etiological test results, the patients were divided into two groups: KPLA group and nKPLA group, and clinical characteristics of the two groups were compared. At the same time, the application value of mNGS in PLA was analyzed.Results:Among the 549 patients, the main clinical symptom of PLA was fever ( n= 503, 91.6%) and other clinical symptoms included chills and abdominal pain. Most patients had a single abscess ( n= 464, 84.5%) located in the right lobe ( n = 368, 67.0%), with a size between 5 and 10 cm ( n= 341, 62.1%). A total of 246 patients had positive etiological test results, including 202 KPLA patients which was the main pathogen of liver abscess. The prevalence of diabetes and fatty liver was higher in KPLA patients ( P < 0.05), but there were more culture of liver positive factors in nKPLA patients ( P < 0.001). Among the 109 patients with traditional microbiological results, 92 patients were suspected to KPLA (Klebsiella pneumoniae), of which 14 patients (15.2%) were multidrug resistant (MDR) infection; 17 patients were suspected to nKPLA, of which 10 patients (58.8%) were MDR infection; the incidence of MDR infection in patients with nKPLA was significantly higher than that in patients with KPLA ( P < 0.05). The positive rate of mNGS in plasma was 85.2%, the positive rate of traditional microbial culture in plasma was 14.8%, the positive rate of mNGS in pus was 96.2% and traditional microbial culture in pus was 65.4%. The positive rate of traditional culture was significantly lower than that of mNGS ( P < 0.05). Conclusions:PLA is usually manifested as fever, single and at the right lobe of the liver. Klebsiella pneumoniae is the most common pathogenic bacteria of PLA, which is more common in patients with diabetes and fatty liver, while non-Klebsiella pneumoniae is relatively more common in patients with culture of liver positive factors. The positive detection rate of mNGS is high, which has a unique advantage in pathogen detection.

Absceso hepático piógeno. Presentación de un caso / Pyogenic liver abscess. Presentation of a case / Abscesso hepático piogênico. Apresentação de um caso

RESUMEN Se presentó el caso clínico de un anciano de 79 años de edad con alcoholismo crónico y otras comorbilidades asociadas, ingresado por fiebre de tres días de evolución y sospecha de dengue en el Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo Portuondo", de la provincia Santiago de Cuba. Por consenso multidisciplinario se diagnosticó absceso hepático piógeno de los subsegmentos VII-VIII del hígado. Se realizó laparotomía de urgencia con drenaje de la colección purulenta. Presentó infección superficial del sitio operatorio, pero la evolución posoperatoria fue satisfactoria y se egresó curado 7 días después.

ABSTRACT The clinical case of a 79-year-old man with chronic alcoholism and other associated comorbidities presented, admitted with a fever of three days of evolution and suspected diagnosis of dengue at the Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo Portuondo", from Santiago de Cuba province. By multidisciplinary consensus, a pyogenic liver abscess of subsegments VII-VIII of the liver was diagnosed. An emergency laparotomy was performed with drainage of the purulent collection. He presented superficial infection of the surgical site, but the postoperative evolution was satisfactory and he was discharged cured 7 days later.

RESUMO Foi apresentado o caso clínico de um idoso de 79 anos com alcoolismo crónico e outras comorbidades associadas, internado por febre de três dias de evolução e suspeita de dengue no Hospital Clínico Quirúrgico Docente "Dr. Ambrosio Grillo Portuondo", da província de Santiago de Cuba. Por consenso multidisciplinar, foi diagnosticado um abscesso hepático piogênico dos subsegmentos VII-VIII do fígado. Foi realizada laparotomia de emergência com drenagem da coleção purulenta. Apresentou infecção superficial no sítio operatório, mas a evolução pós-operatória foi satisfatória e teve alta curado 7 dias após.

Clinical characteristics of 528 patients with pyogenic liver abscess / 中华传染病杂志

Objective:To analyze and summarize the clinical features of pyogenic liver abscess (PLA) patients treated in 10 years, so as to provide evidence to improve current diagnosis and corresponding treatment strategies of PLA.Methods:The clinical symptoms, signs, laboratory and imaging findings, etiology and different treatments as well as corresponding efficacy and prognosis of PLA patients treated in Xiangya Hospital of Central South University during January 2010 to December 2019 were retrospectively analyzed.The chi-square was used to evaluate the differences of the categorical variables.Results:A total of 528 PLA cases were included in this study.Diabetes mellitus (46.8%, 247/528), biliary tract diseases (34.7%, 183/528) and previous hepatobiliary surgery history (19.7%, 104/528) were three most common risk factors leading to PLA. Fever (80.9%, 427/528), loss of appetite (53.6%, 283/528) and abdominal pain (51.9%, 274/528) were most common clinical manifestations. The accuracies of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were 95.5%(472/494), 97.0%(384/396), and 96.8%(92/95), respectively. The positive rate of pus culture (70.9%, 168/237) was higher than that of blood culture (20.0%, 42/210), and the difference was statistically significant ( χ2=115.746, P<0.01). The top three most common bacteria were Klebsiella pneumoniae (122 strains), Escherichia coli (29 strains) and Enterococcus faecium (10 strains). The drug resistance rate of Klebsiella pneumoniae to ampicillin was as high as 97.4%(112/115). The treatment programs included 200 cases of sole antibiotic treatments. Based on the antibiotic treatment, imaging guided percutaneous puncture therapy was the most commonly used treatment (45.6%, 241/528), included imaging guided percutaneous puncture and drainage (29.0%, 153/528) and imaging guided percutaneous catheterization (16.7%, 88/528). The surgical treatments included surgical catheter drainage (5.5%, 29/528) and surgical hepatectomy(11.0%, 58/528). The total number of cured cases was 495, and the cure rate was 93.8%. Conclusions:The common clinical manifestations of PLA are fever, loss of appetite, abdominal pain. Ultrasound is a routine and effective method to detect liver abscess. Klebsiella pneumoniae is the most common pathogen. Imaging guided percutaneous puncture is the most common treatment.

Síndrome de absceso hepático invasor por Klebsiella pneumoniae, serie de casos / Invasive liver abscess syndrome caused by Klebsiella pneumoniae, case series

Resumen Introducción: Los abscesos hepáticos primarios producidos por Klebsiella pneumoniae y las implicancias sistémicas relacionadas constituyen el síndrome de absceso hepático invasor por Klebsiella pneumoniae. Objetivo: Describir las características clínicas, epidemiológicas y la evolución de esta entidad en nuestro centro. Pacientes y Métodos: Cohorte retrospectiva de pacientes adultos internados en el Hospital Italiano de Buenos aires entre el 1 de enero de 2001 y el 1 de mayo de 2020. Se incluyeron pacientes con diagnóstico de absceso en cualquier órgano con aislamiento en cultivo de absceso o hemocultivo positivo para Klebsiella pneumoniae para ser analizadas las características epidemiológicas, clínicas y la evolución de aquellos con localización primaria hepática. Resultados: 10 pacientes fueron incluidos. Dos (20%) pacientes fueron orientales. La mediana de edad fue 69 años (IIC 64-79), nueve (90%) fueron hombres. La co-morbilidad más frecuente fue diabetes mellitus tipo 2 (40%). Cuatro (40%) pacientes tuvieron diseminación a otros órganos. La mediana de internación fue 21,5 días (IIC 15-43), 60% (n: 6) requirió internación en unidad de cuidados intensivos y 30% (n: 3) de los pacientes falleció. Conclusión: El síndrome de absceso hepático invasor por Klebsiella pneumoniae es una enfermedad infrecuente, potencialmente mortal. Este estudio intenta reportar las características de los pacientes con esta patología en nuestra población.

Abstract Background: Primary liver abscesses caused by Klebsiella pneumoniae and their related systemic complications produce the invasive liver abscess syndrome due to Klebsiella pneumoniae. Aim: To describe the clinical, epidemiological and evolution characteristics in our center. Methods: A retrospective cohort of hospitalized adults in Hospital Italiano de Buenos Aires between January 1st, 2001 and May 1st, 2020. We included patients with diagnosis of abscess in any organ with rescue in culture or positive blood culture for Klebsiella pneumoniae. Epidemiological, clinical characteristics and prognosis of those with hepatic primary localization were analyzed. Results: 10 patients were included. Two (20%) patients were Oriental. Median age was 69 years (interquartile range 64-79), nine (90%) were men. The most frequent comorbidity was type 2 diabetes (40%). Four (40%) patients had spread to other organs. The median hospitalization was 21.5 days (IIC 15-43), 60% (n: 6) were hospitalized in the intensive care unit and 30% (n: 3) died. Conclusions: The invasive liver abscess syndrome due to Klebsiella pneumoniae is a rare life-threatening disease. Our study reports the characteristics of patients with this syndrome in our population.

Ruptured pyogenic liver abscess in pregnancy: a case report

Pyogenic liver abscess during pregnancy is an extremely dangerous condition, both from general as well as obstetric point of view. An interesting case of 24-year primigravida reported at 28 weeks gestation with high grade fever and chills with features of peritonitis is being presented here, which on investigations subsequently was diagnosed to be a case of ruptured pyogenic liver abscess. The case was managed successfully with higher antibiotics and percutaneous drainage of the abscess. The obstetric outcome was successful as well, with spontaneous preterm delivery of 920 gm male child which cried immediately after birth and was managed with appropriate care in premature baby unit.

Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management.

Absceso hepático piogénico en pediatría: a propósito de un caso clínico de difícil diagnóstico / Pyogenic liver abscess in pediatrics: a difficult to diagnose clinical case / Abscesso hepático piogênico em pediatria: relato de caso de difícil diagnóstico

Resumen: El absceso hepático (AH) es una patología poco frecuente pero bien definida en la infancia. Requiere un diagnóstico precoz para iniciar el tratamiento adecuado y disminuir su morbimortalidad. Las manifestaciones clínicas son inespecíficas. En la mayoría de los casos la etiología es bacteriana y la vía de acceso es a través de una bacteriemia. El germen más frecuente es Staphylococcus aureus. Se presenta el caso de una niña de 2 años, previamente sana, con el antecedente de una infección de piel que pasó desapercibida. Consultó por un cuadro febril de varios días de evolución, con signo-sintomatología acompañante inespecífica. En la pesquisa diagnóstica se realizaron exámenes imagenológicos que revelaron la presencia de una tumoración en hipocondrio izquierdo. A través de una laparoscopía exploratoria se diagnosticó y drenó un absceso único en el lóbulo izquierdo del hígado. El pus extraído cultivó S. aureus meticilino sensible. Recibió tratamiento antibiótico durante un mes, con excelente evolución posterior. Al mes despareció la cavidad residual por ecografía. El interés de esta comunicación radica en la baja frecuencia de esta patología en niños y las dificultades diagnósticas que genera.

Summary: Liver abscess (LA) is a rare but well-defined child pathology that requires an accurate, adequate and early diagnosis and treatment, in order to prevent further morbidity and mortality. The clinical symptoms are not specific. In most cases, LA has a bacterial etiology and the access way is through bacteremia. The most frequent germ is Staphylococcus aureus. The case presented involves a two-year old girl, previously healthy, with a history of an unnoticed skin infection. She consulted for a several day-long fever, with nonspecific accompanying signs or symptoms. We performed imagenology tests during diagnosis that revealed the presence of a tumor in the left hypochondrium. We were able to perform an exploratory laparoscopy, diagnose and drain a single abscess in the left liver lobe. The extracted pus culture showed methicillin-sensitive S. aureus. She received antibiotic treatment for a month, with excellent further evolution. A month after the procedure, the residual cavity had disappeared when checked via ultrasound. This pathology is interesting due to its low frequency in children and to its diagnostic difficulties.

Resumo: O abscesso hepático (AE) é uma patologia infantil rara, porém bem definida, que requer diagnóstico e tratamento precoces, a fim de evitar morbimortalidade maior. Suas manifestações clínicas não são específicas. Na maioria dos casos, é de etiologia bacteriana e a via de acesso é por bacteremia. O germe mais frequente é o Staphylococcus areus. Apresentamos o caso duma menina de dois anos, previamente saudável, com história de infecção cutânea despercebida. Ela consultou por uma febre de vários dias, com sintomatologia não específica. Durante o diagnóstico realizamos exames imagiológicos que revelaram a presença de um tumor no hipocôndrio esquerdo. Fomos capazes de realizar uma laparoscopia exploratória e diagnosticar e drenar um abscesso único no lobo esquerdo do fígado. O pus extraído cultivou S. aureus sensível à meticilina. Ela recebeu tratamento com antibiótico por um mês, com excelente evolução posterior. Um mês após utilizamos o ultrassom em constatamos que a cavidade residual tinha desaparecido. Essa patologia é interessante devido à baixa frequência em crianças e as suas dificuldades diagnósticas.

Absceso hepático piógeno en pediatría: serie de casos / Pyogenic liver abscess in children: a case series

El absceso hepático es un reto diagnóstico y terapéutico. Es una patología poco frecuente en la niñez que predomina en países en desarrollo y se asocia a malnutrición y parasitosis. El absceso hepático piógeno es el más frecuente, es una causa de hospitalización prolongada por el requerimiento de antimicrobianos endovenosos; usualmente con baja mortalidad. A continuación, presentamos una serie de cuatro casos clínicos de pacientes con abscesos hepáticos piógenos que fueron manejados entre el 2016 y 2018 en el Hospital de Especialidades Pediátricas. Tres pacientes fueron del sexo femenino y uno masculino. En dos de los pacientes se identi có factor predisponente: diabetes mellitus e infección avanzada por VIH. Los síntomas más frecuentes fueron ebre (100%), dolor abdominal (100%) y hepatomegalia (50%). En ninguno de los casos se sospechó absceso hepático a su ingreso. Los casos fueron diagnosticados por sonograma hepático y corroborados con tomografía abdominal. El tamaño promedio de las lesiones fue de 6.88 x 6.18 x 6.12 cm. Tres fueron de localización derecha y uno de localización izquierda. Todos los pacientes recibieron antibioticoterapia de amplio espectro y drenaje percutáneo. Se identi có agente etiológico en uno de los pacientes: Staphylococcus aureus. Los pacientes recibieron una media de 33 + 3.5 días de tratamiento. Con evolución favorable en todos los casos y mejoría en seguimiento con ultrasonidos. Ningún paciente requirió intervención quirúrgica.

The liver abscess involves an authentic diagnostic and therapeutic challenge. It is not frecuent in childhood. Occurs mainly in developing countries and is associated to malnutrition and parasitic infection, that are described as risk factors. Pyogenic liver abscess represents, in most of the cases, a cause of long-time hospitalizations because of the requirement of endovenous treatment, but usually with low mortality. We describe a four-case series of patients with pyogenic liver abscess between 2016 and 2018 in Hospital de Especialidades Pediatricas in Panamá City. Three patients were female and one was a male. In two of the cases, there were risk factors such as diabetes mellitus and advanced HIV infection. The most frequent symptoms were: fever (100%), abdominal pain (100%) and hepatomegaly (50%). In neither one of the cases, liver abscess was suspected as diagnosis. All cases were diagnosed by hepatic sonogram and con rmed by abdominal CT- scan. The mean size of lesions was 6.88 x 6.18 x 6.12 cm. Three of the cases were located in right lobe and one in the left lobe of the liver. They were managed with broad-spectrum antibiotics and percutaneous drainage. Staphylococcus aureus was isolated in one case. The patients received a mean of 33 + 3.5 days of treatment. All cases evolved well with improvement of lesion in ultrasonography. None of the patients required surgical intervention.

Bacterial flora distribution and antimicrobial resistance of pyogenic liver abscess: a multicenter retrospective study (A report of 897 cases) / 中华消化外科杂志

Objective@#To investigate the bacterial flora distribution and antimicrobial resistance of patients with pyogenic liver abscess (PLA) in multi-centers of China.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 897 patients with PLA at 3 medical centers in China from October 2007 to April 2018 were collected, including 656 cases in the First Hospital of Harbin Medical University, 109 cases in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and 132 cases in the Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University. There were 582 males and 315 females, aged (59±11)years, with a range of 6-86 years. Observation indicators: (1) bacterial flora distribution; (2) bacterial resistance. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages.@*Results@#(1) Bacterial flora distribution: among 897 patients, 733 cases of Klebsiella pneumoniae, 75 cases of Escherichia coli, 11 cases of Staphylococcus aureus, 10 cases of Streptococcus viridians, 9 cases of Klebsiella pneumoniae subsp. pneumoniae, 7 cases of β-emolytic streptococcus, 6 cases of Acinetobacter baumannii, 5 cases of Streptococcus intermadius, 5 cases of Enterococcus faecium, 3 cases of Alcaligenes xylosoxidans subsp. xylosoxidans, 2 cases of Proteus mirabilis, 2 cases of Streptococcus isthmus, 2 cases of Enterobacter cloacae subsp. cloacae, 1 case of Citrobacter koseri, 1 case of Proteus vulgaris, 1 case of Pasteurella pneumotropica, 1 case of Curobacter freudii, 1 case of Enterobacter amnigenus, 1 case of Stenotrophomonas maltophilia, 1 case of Acinetobacter lwoffii, 1 case of Streptococcus salivarius, 1 case of Streptococcus bacterium, 1 case of Enterococcus avium, 1 case of Enterococcus faecalis, 1 case of Klebsiella oxytoca, and 1 case of Staphylococcus epidermidis were cultured in the pus respectively. There were 12 cases of double bacterial infection, and 2 cases of multiple bacterial infections. (2) Bacterial resistance. ① Resistance of Klebsiella pneumoniae and Escherichia coli: the drug resistance rates of Klebsiella pneumoniae to ampicillin, piperacillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefotetan, cefepime, cefoxitin, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, ertapenem, gentamicin, tobramycin, amikacin, tigaricycline, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 99.79%(474/475), 4.09%(7/171), 12.18%(82/673), 7.34%(49/668), 2.34%(4/171), 1.96%(11/562), 5.85%%(10/171), 0(0/562), 0.55%(4/733), 1.42%(9/635), 0(0/733), 2.46%(18/733), 0.55%(4/733), 0.27%(2/733), 1.36%(10/733), 0.14%(1/733), 0(0/733), 0.36%(2/562), 0.95%(7/733), 0.41%(3/733), 0(0/733), 0(0/562), 1.64%(12/733), 0.95%(7/733), and 4.50%(33/733), respectively. The drug resistance rates of Escherichia coli to above antibiotics were 78.67%(59/75), 40.91%(18/44), 65.33%(49/75), 56.00%(42/75), 38.64%(17/44), 41.94%(13/31), 20.00%(15/75), 3.23%(1/31), 25.33%(19/75), 5.77%(3/52), 18.67%(14/75), 32.00%(24/75), 8.00%(6/75), 16.00%(12/75), 37.33%(28/75), 1.33%(1/75), 0(0/75), 0(0/31), 40.00%(30/75), 14.67%(11/75), 1.33%(1/75), 0(0/31), 54.67%(41/75), 37.33%(28/75), and 52.00%(39/75), respectively. ② Drug resistance of other Gram-negative bacteria: the drug resistance rates of Klebsiella pneumoniae subsp. pneumoniae to ampicillin, cefazolin, cefuroxime, ceftriaxone, ceftazidime, cefotetan, cefepime, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, ertapenem, gentamicin, tobramycin, amikacin, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 8/8, 0/5, 0/5, 0/1, 0/9, 0/2, 0/9, 0/8, 0/9, 0/9, 0/6, 0/9, 0/9, 0/7, 0/1, 0/9, 0/8, 0/9, 0/9, 0/9, and 0/9. The drug resistance rates of Acinetobacter baumannii to ceftriaxone, ceftazidime, cefepime, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, gentamicin, tobramycin, amikacin, tigaricycline, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 2/6, 4/6, 3/6, 0/6, 4/6, 1/6, 2/6, 4/6, 2/6, 4/6, 4/6, 3/6, 0/6, 4/6, 2/6, and 3/6, respectively. The drug resistance rates of Alcaligenes xylosoxidans subsp. xylosoxidans to ampicillin, cefazolin, cefuroxime, ceftazidime, cefepime, amoxicillin/carat Retinoic acid, piperacillin/tazobactam, aztreonam, imipenem, gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin were 3/3, 3/3, 3/3, 1/3, 1/3, 1/3, 0/3, 3/3, 2/3, 3/3, 3/3, 3/3, 3/3, and 1/3. ③ Drug resistance of other Gram-positive bacteria: the drug resistance rates of Staphylococcus aureus to penicillin, ampicillin, piperacillin, cefazolin, cefuroxime, cefotaxime, ceftazidime, cefepime, cefoxitin, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, gentamicin, tobramycin, amikacin, tetracycline, tigaricycline, ciprofloxacin, levofloxacin, moxifloxacin, trimethoprim sulfamethoxazole, linezolid, erythromycin, clindamycin, vancomycin, teicoplanin, and rifampin were 2/6, 6/8, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 3/5, 2/5, 2/5, 3/8, 3/5, 3/5, 0/8, 0/8, 3/8, 3/11, 0/5, 1/8, 0/8, 0/8, 2/6, 3/3, 1/3, and 0/3. The drug resistance rates of Streptococcus viridians to penicillin, ampicillin, ceftriaxone, cefoperazone/sulbactam, gentamicin, tetracycline, ciprofloxacin, levofloxacin, moxifloxacin, linezolid, erythromycin, clindamycin, vancomycin, teicoplanin, and rifampin were 3/10, 0/8, 0/7, 0/7, 2/8, 6/10, 0/8, 0/8, 0/7, 0/5, 4/10, 6/10, 0/5, 0/5, and 0/3. The drug resistance rates of β-emolytic streptococcus to antibacterial agents were 0. ④ Drug resistance of complex bacteria. For the 12 patients with double bacterial infection, in the Klebsiella pneumoniae combined with Gram-negative bacteria, the drug resistance rates of Klebsiella pneumoniae to cefotetan, cefoxitin, ampicillin/sulbactam, meropenem, ertapenem, tobramycin, tigecycline, and trimethoprim sulfamethoxazole were 0. The drug resistance rates of Acinetobacter baumannii to ertapenem, levofloxacin, and trimethoprim sulfamethoxazole were 0. The drug resistance rates of Escherichia coli to ceftazidime, cefoxitin, amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, meropenem, ertapenem, tobramycin, amikacin, and tigecycline were 0. Citrobacter florida was sensitive to other antibiotics than levofloxacin and trimethoprim cotrimoxazole. In the Escherichia coli combined with Gram-positive bacteria, the drug resistance rates of Escherichia coli to cefotetan, cefepime, cefoxitin, cefoperazone/sulbactam, meropenem, tobramycin, and amikacin were 0. The drug resistance rates of Enterococcus faecalis to penicillin, ampicillin, levofloxacin, moxifloxacin, linezolid, vancomycin, and teicoplanin were 0. The drug resistance rates of Enterococcus casselifavus to ampicillin, tetracycline, levofloxacin, moxifloxacin, linezolid, and erythromycin were 0. The drug resistance rates of Staphylococcus hominis subspecies to levofloxacin, moxifloxacin, linezolid, vancomycin, teicoplanin, and rifampicin were 0. The drug resistance rates of Enterococcus faecium to tetracycline, linezolid, vancomycin, and teicoplanin were 0. In the multiple bacterial infections of Klebsiella pneumoniae + Escherichia coli + Staphylococcus aureus subspecies + Pseudomonas aeruginosa + Torulopsis glabrata, the drug resistance rates of Klebsiella pneumoniae to ceftriaxone, ceftazidime, cefotetan, cefepime, cefoxitin, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, tobramycin, amikacin, and levofloxacin were 0. The drug resistance rates of Escherichia coli to ceftazidime, cefotetan, cefepime, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, and amikacin were 0. The drug resistance rates of Staphylococcus aureus subspecies to ceftriaxone, ceftazidime, cefotetan, cefepime, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, tobramycin, amikacin, tigecycline, moxifloxacin, cotrimoxazole, teicoplanin, vancomycin, linezolid, and clindamycin were 0. The drug resistance rates of Pseudomonas aeruginosa to ceftazidime, cefepime, piperacillin/tazobactam, imipenem, gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin were 0. The drug resistance rates of Torulopsis glabrata to 5-fluorocytosine, fluconazole, itraconazole, and voriconazole were 0. In the multiple bacterial infections of Klebsiella pneumoniae + Escherichia coli + Acinetobacter baumannii, the drug resistance rates of Klebsiella pneumoniae to cefotetan, cefepime, piperacillin/tazobactam, imipenem, ertapenem, tobramycin, ciprofloxacin, and levofloxacin were 0. The drug resistance rates of Escherichia coli to amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, meropenem were 0. The drug resistance ratets of Acinetobacter baumannii to trimethoprim sulfamethoxazole was 0.@*Conclusions@#Klebsiella pneumoniae is the main pathogen of PLA, followed by Escherichia coli. Klebsiella pneumoniae and Escherichia coli are sensitive to meropenem and tigecycline. Klebsiella pneumoniae subsp. pneumoniae and other Gram-negative bacteria are sensitive to ertapenem. Staphylococcus aureus are sensitive to Linezolid. Antibiotics are selected after drug sensitivity test for patients.

Bacterial flora distribution and antimicrobial resistance of pyogenic liver abscess: a multicenter retrospective study (A report of 897 cases) / 中华消化外科杂志

Objective To investigate the bacterial flora distribution and antimicrobial resistance of patients with pyogenic liver abscess (PLA) in multi-centers of China.Methods The retrospective and descriptive study was conducted.The clinical data of 897 patients with PLA at 3 medical centers in China from October 2007 to April 2018 were collected,including 656 cases in the First Hospital of Harbin Medical University,109 cases in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and 132 cases in the Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University.There were 582 males and 315 females,aged (59± 11) years,with a range of 6-86 years.Observation indicators:(1) bacterial flora distribution;(2) bacterial resistance.Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers or percentages.Results (1) Bacterial flora distribution:among 897 patients,733 cases of Klebsiella pneumoniae,75 cases of Escherichia coli,11 cases of Staphylococcus aureus,10 cases of Streptococcus viridians,9 cases of Klebsiella pneumoniae subsp.pneumoniae,7 cases of β-emolytic streptococcus,6 cases of Acinetobacter baumannii,5 cases of Streptococcus intermadius,5 cases of Enterococcus faecium,3 cases of Alcaligenes xylosoxidans subsp.xylosoxidans,2 cases of Proteus mirabilis,2 cases of Streptococcus isthmus,2 cases of Enterobacter cloacae subsp.cloacae,1 case of Citrobacter koseri,1 case of Proteus vulgaris,1 case of Pasteurella pneumotropica,1 case of Curobacter freudii,1 case of Enterobacter amnigenus,1 case of Stenotrophomonas maltophilia,1 case of Acinetobacter lwoffii,1 case of Streptococcus salivarius,1 case of Streptococcus bacterium,1 case of Enterococcus avium,1 case of Enterococcus faecalis,1 case of Klebsiella oxytoca,and 1 case of Staphylococcus epidermidis were cultured in the pus respectively.There were 12 cases of double bacterial infection,and 2 cases of multiple bacterial infections.(2) Bacterial resistance.① Resistance of Klebsiella pneumoniae and Escherichia coli:the drug resistance rates of Klebsiella pneumoniae to ampicillin,piperacillin,cefazolin,cefuroxime,cefotaxime,ceftriaxone,ceftazidime,cefotetan,cefepime,cefoxitin,amoxicillin/carat Retinoic acid,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/sulbactam,aztreonam,imipenem,meropenem,ertapenem,gentamicin,tobramycin,amikacin,tigaricycline,ciprofloxacin,levofloxacin,and trimethoprim sulfamethoxazole were 99.79％ (474/475),4.09％ (7/171),12.18％ (82/673),7.34％(49/668),2.34％(4/171),1.96％(11/562),5.85％％(10/171),0(0/562),0.55％(4/733),1.42％(9/635),0(0/733),2.46％(18/733),0.55％(4/733),0.27％(2/733),1.36％(10/733),0.14％ (1/733),0 (0/733),0.36％ (2/562),0.95％ (7/733),0.41％ (3/733),0 (0/733),0 (0/562),1.64％ (12/733),0.95％ (7/733),and 4.50％ (33/733),respectively.The drug resistance rates of Escherichia coli to above antibiotics were 78.67％ (59/75),40.91％ (18/44),65.33％ (49/75),56.00％ (42/75),38.64％ (17/44),41.94％ (13/31),20.00％ (15/75),3.23％ (1/31),25.33％ (19/75),5.77％ (3/52),18.67％ (14/75),32.00％(24/75),8.00％(6/75),16.00％(12/75),37.33％(28/75),1.33％(1/75),0(0/75),0(0/31),40.00％(30/75),14.67％(11/75),1.33％(1/75),0(0/31),54.67％(41/75),37.33％ (28/75),and 52.00％ (39/75),respectively.② Drug resistance of other Gram-negative bacteria:the drug resistance rates of Klebsiella pneumoniae subsp.pneumoniae to ampicillin,cefazolin,cefuroxime,ceftriaxone,ceftazidime,cefotetan,cefepime,amoxicillin/carat Retinoic acid,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/sulbactam,aztreonam,imipenem,meropenem,ertapenem,gentamicin,tobramycin,amikacin,ciprofloxacin,levofloxacin,and trimethoprim sulfamethoxazole were 8/8,0/5,0/5,0/1,0/9,0/2,0/9,0/8,0/9,0/9,0/6,0/9,0/9,0/7,0/1,0/9,0/8,0/9,0/9,0/9,and 0/9.The drug resistance rates of Acinetobacter baumannii to ceftriaxone,ceftazidime,cefepime,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/sulbactam,aztreonam,imipenem,meropenem,gentamicin,tobramycin,amikacin,tigaricycline,ciprofloxacin,levofloxacin,and trimethoprim sulfamethoxazole were 2/6,4/6,3/6,0/6,4/6,1/6,2/6,4/6,2/6,4/6,4/6,3/6,0/6,4/6,2/6,and 3/6,respectively.The drug resistance rates of Alcaligenes xylosoxidans subsp.xylosoxidans to ampicillin,cefazolin,cefuroxime,ceftazidime,cefepime,amoxicillin/carat Retinoic acid,piperacillin/tazobactam,aztreonam,imipenem,gentamicin,tobramycin,amikacin,ciprofloxacin,and levofloxacin were 3/3,3/3,3/3,1/3,1/3,1/3,0/3,3/3,2/3,3/3,3/3,3/3,3/3,and 1/3.③ Drug resistance of other Gram-positive bacteria:the drug resistance rates of Staphylococcus aureus to penicillin,ampicillin,piperacillin,cefazolin,cefuroxime,cefotaxime,ceftazidime,cefepime,cefoxitin,amoxicillin/carat Retinoic acid,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/sulbactam,aztreonam,imipenem,meropenem,gentamicin,tobramycin,amikacin,tetracycline,tigaricycline,ciprofloxacin,levofloxacin,moxifloxacin,trimethoprim sulfamethoxazole,linezolid,erythromycin,clindamycin,vancomycin,teicoplanin,and rifampin were 2/6,6/8,4/5,4/5,4/5,4/5,4/5,4/5,4/5,4/5,4/5,4/5,4/5,3/5,2/5,2/5,3/8,3/5,3/5,0/8,0/8,3/8,3/11,0/5,1/8,0/8,0/8,2/6,3/3,1/3,and 0/3.The drug resistance rates of Streptococcus viridians to penicillin,ampicillin,ceftriaxone,cefoperazone/sulbactam,gentamicin,tetracycline,ciprofloxaein,levofloxaein,moxifloxacin,linezolid,erythromycin,clindamycin,vancomycin,teicoplanin,and rifampin were 3/10,0/8,0/7,0/7,2/8,6/10,0/8,0/8,0/7,0/5,4/10,6/10,0/5,0/5,and 0/3.The drug resistance rates of β-emolytic streptococcus to antibacterial agents were 0.④ Drug resistance of complex bacteria.For the 12 patients with double bacterial infection,in the Klebsiella pneumoniae combined with Gramnegative bacteria,the drug resistance rates of Klebsiella pneumoniae to cefotetan,cefoxitin,ampicillin/sulbactam,meropenem,ertapenem,tobramycin,tigecycline,and trimethoprim sulfamethoxazole were 0.The drug resistance rates of Acinetobacter baumannii to ertapenem,levofloxacin,and trimethoprim sulfamethoxazole were 0.The drug resistance rates of Escherichia coli to ceftazidime,cefoxitin,amoxicillin/clavulanic acid,piperacillin/tazobactam,imipenem,meropenem,ertapenem,tobramycin,amikacin,and tigecycline were 0.Citrobacter florida was sensitive to other antibiotics than levofloxacin and trimethoprim cotrimoxazole.In the Escherichia coli combined with Gram-positive bacteria,the drug resistance rates of Escherichia coli to cefotetan,cefepime,cefoxitin,cefoperazone/sulbactam,meropenem,tobramycin,and amikacin were 0.The drug resistance rates of Enterococcus faecalis to penicillin,ampicillin,levofloxacin,moxifloxacin,linezolid,vancomycin,and teicoplanin were 0.The drug resistance rates of Enterococcus casselifavus to ampicillin,tetracycline,levofloxacin,moxifloxacin,linezolid,and erythromycin were 0.The drug resistance rates of Staphylococcus hominis subspecies to levofloxacin,moxifloxacin,linezolid,vancomycin,teicoplanin,and rifampicin were 0.The drug resistance rates of Enterococcus faecium to tetracycline,linezolid,vancomycin,and teicoplanin were 0.In the multiple bacterial infections of Klebsiella pneumoniae + Escherichia coli + Staphylococcus aureus subspecies + Pseudomonas aeruginosa + Torulopsis glabrata,the drug resistance rates of Klebsiella pneumoniae to ceftriaxone,ceftazidime,cefotetan,cefepime,cefoxitin,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/sulbactam,aztreonam,imipenem,tobramycin,amikacin,and levofloxacin were 0.The drug resistance rates of Escherichia coli to ceftazidime,cefotetan,cefepime,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/sulbactam,aztreonam,imipenem,and amikacin were 0.The drug resistance rates of Staphylococcus aureus subspecies to ceftriaxone,ceftazidime,cefotetan,cefepime,ampicillin/sulbactam,piperacillin/tazobactam,cefoperazone/ sulbactam,aztreonam,imipenem,tobramycin,amikacin,tigecycline,moxifloxacin,cotrimoxazole,teicoplanin,vancomycin,linezolid,and clindamycin were 0.The drug resistance rates of Pseudomonas aeruginosa to ceftazidime,cefepime,piperacillin/tazobactam,imipenem,gentamicin,tobramycin,amikacin,ciprofloxacin,and levofloxacin were 0.The drug resistance rates of Torulopsis glabrata to 5-fluorocytosine,fluconazole,itraconazole,and voriconazole were 0.In the multiple bacterial infections of Klebsiella pneumoniae + Escherichia coli + Acinetobacter baumannii,the drug resistance rates of Klebsiella pneumoniae to cefotetan,cefepime,piperacillin/tazobactam,imipenem,ertapenem,tobramycin,ciprofloxacin,and levofloxacin were 0.The drug resistance rates of Escherichia coli to amoxicillin/clavulanic acid,piperacillin/tazobactam,imipenem,meropenem were 0.The drug resistance ratets of Acinetobacter baumannii to trimethoprim sulfamethoxazole was 0.Conclusions Klebsiella pneumoniae is the main pathogen of PLA,followed by Escherichia coli.Klebsiella pneumoniae and Escherichia coli are sensitive to meropenem and tigecycline.Klebsiella pneumoniae subsp.pneumoniae and other Gram-negative bacteria are sensitive to ertapenem.Staphylococcus aureus are sensitive to Linezolid.Antibiotics are selected after drug sensitivity test for patients.

Efficacy of radiofrequency ablation in treatment of complicated pyogenic liver abscess / 中华肝胆外科杂志

Objective To evaluate the efficacy of radiofrequency ablation (RFA) in treatment of complicated pyogenic liver abscess (PLA).Methods A retrospective analysis was conducted on 20 patients with complicated PLA treated from August 2010 to January 2018 in the West Campus of Beijing Chao-yang Hospital which is Affiliated to the Capital Medical University and Rizhao Central Hospital of Shandong Province.These patients were treated with RFA based treatment modalities using CT-guided or laparoscopy combined with Ultrasound-guided RFA.The successful rate,efficacious rate and safety of RFA were respectively analyzed.Routine follow-up was carried out after treatment.Results The successful rate of RFA was 100％.The median operation time was 45 minutes.All the 20 patients were cured by one session of RFA.The multilocular lesion in one patient was converted to a unilocular lesion after one session of RFA.The patient was then cured by percutaneous hepatic abscess drainage.No serious complications were observed.Conclusions RFA was safe and efficacious.It should be considered as an alternative treatment for patients with complicated PLA who were not responsive to,or not applicable to antibiotics treatment and radiological intervention.

Absceso hepático piógeno en pediatría: experiencia en un centro pediátrico de referencia / Pyogenic liver abscess in children: clinical experience in a pediatric reference center

Introduction: Liver abscess is a serious and an uncommon pediatric disease. Objective and Method: Description of 20 pediatric patients with liver abscess admitted in "Ricardo Gutierrez" Children’s Hospital, a Tertiary Reference Center of Buenos Aires, between 2009 and 2015. Results: The hospitalization rate was 35/100.000 admissions. Median age was 5 years old, male/female ratio 4/1. Five patients (25%) had predisposing factors. Median days at diagnosis were 12. Features: Fever 100%, prolonged fever 60%, abdominal pain 50%. The majority had leukocytosis and elevated CRP (median 160 mg/L). Liver enzymes were elevated in only 40% of patients. Ultrasonography detected 90%. A single abscess was observed in 60%; localized at right hepatic lobe, 65%. Purulent material was positive in 12/17 (70%) and bacteremia was present in 3/20 (15%). Wide empirical antibiotic therapy was used. Treatment shift was needed in four patients. The median days of intravenous antibiotics were 30 and the median of total treatment were 53. Surgical procedures were performed in 13/20 (65%). Conclusion: Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was the most frequent pathogen, especially in healthy children that associated skin or respiratory illness. Appropriate antibiotic treatment and eventual drainage allows good outcome without sequela or deaths.

Resumen Introducción: El absceso hepático es una patología infrecuente en pediatría. Objetivo y Métodos: Describir las características de 20 pacientes ingresados entre 2009-2015 en el Hospital de Niños "R. Gutiérrez", Centro de Referencia de Nivel T erciario de Buenos Aires, Argentina con diagnóstico de absceso hepático. Resultados: La tasa de hospitalización fue 35/100.000 admisiones. La mediana de edad fue 5 años, relación masculino/femenino: 4/1. Cinco pacientes tuvieron factores predisponentes. La mediana de duración de la enfermedad al diagnóstico fue de 12 días. Todos los pacientes presentaron fiebre, 60% síndrome febril prolongado y 50% dolor abdominal. La mayoría tenía leucocitosis y PCR elevada (mediana 160 mg/L). Sólo 40% tuvo alteración de pruebas hepáticas. En 90% de los casos el diagnóstico se realizó por ecografía, 65% estaban localizados en el lóbulo derecho; 60% eran lesiones únicas. Hubo aislamiento microbiológico en 12/17 (70%) y en 3/20 (15%) de hemocultivos. Todos recibieron tratamiento antibacteriano empírico de amplio espectro. La mediana de tratamiento antibacteriano intravenoso fue 30 días y en total 53 días. Se realizó drenaje quirúrgico en 13 casos. Todos evolucionaron favorablemente. Conclusión: Staphylococcus aureus resistente a meticilina de la comunidad (SARM-AC) fue el patógeno predominante, especialmente en niños previamente sanos asociados a un foco cutáneo o respiratorio.

Pyogenic liver abscess: diagnostic and therapeutic management / Abscesso hepático piogênico: manejo dos recursos diagnósticos e terapêuticos

ABSTRACT Background: The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay. Aim: Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment. Method: Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated. Results: The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death. Conclusion: The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource.

RESUMO Racional: O abscesso hepático piogênico tem incidência de 1,1 por 1.000 habitantes com mortalidade podendo chegar a 100%. O uso de recursos menos invasivos diminuem morbimortalidade e tempo de internação hospitalar. Objetivo: Identificar fatores de risco no abscesso hepático piogênico tratado por drenagem percutânea guiada por ultrassom. Método: Total de 10 pacientes foram submetidos ao procedimento. Foram avaliadas características epidemiológicas, marcadores laboratoriais exames de imagem (ultrassom e tomografia). Resultados: Na amostra houve predominância do sexo masculino, com média de idade de 50 anos. Hepatopatia, etilismo e doença da via biliar foram os pródromos mais frequentes. Dor abdominal (90%), febre (70%) e icterícia (40%) foram manifestações clínicas mais comuns. Houve mortalidade de 20% nesta série. Hipoalbuminemia e dias de internação hospitalar tiveram associação positiva com óbito estatisticamente significante. Conclusão: O abscesso hepático piogênico tem evolução subaguda o que dificulta o diagnóstico. Exames de imagem têm sensibilidade alta na propedêutica diagnóstica, notadamente a tomografia computadorizada. A drenagem percutânea, associada à antibioticoterapia, mostrou ser recurso terapêutico seguro e eficaz.

Predictors of Mortality in Korean Patients with Pyogenic Liver Abscess: A Single Center, Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: The mortality rate of pyogenic liver abscess (PLA) has decreased dramatically, but it remains a potentially life threatening disease. Most cases are cryptogenic or occur in elderly men with underlying biliary tract disease. Although several studies have addressed the characteristics and etiology of PLA, research on factors affecting PLA-associated mortality is lacking. This study intended to identify the clinical and radiological features, pathogens, complications, and predictors of mortality in Korean PLA patients. METHODS: The medical records of 231 PLA patients diagnosed at Yeungnam University Medical Center between January 2010 and January 2014 were analyzed. A diagnosis of PLA was made based on imaging studies and blood and abscess cultures. The clinical, radiological, and laboratory findings of patients were analyzed. RESULTS: The mean patient age was 64.0±12.9 years and the male to female ratio was 1.5:1. Klebsiella pneumoniae was the predominant organism isolated from hepatic abscesses (69.9%) and blood (74.2%). The most common complication was pleural effusion (35.8%) and most common co-infection was cholangitis (8.2%). The overall mortality rate of PLA was 6.9% (16/231), and was significantly higher in patients with a history of liver abscess (OR 5.970, 95% CI 1.207-29.529; p=0.028), bilirubinemia (>2 mg/dL) (OR 9.541, 95% CI 2.382-38.216; p=0.001), thrombocytopenia (<140×10(3)/µL) (OR 4.396, 95% CI 1.130-17.106; p=0.033), or anemia (<12 g/dL) (OR 13.277, 95% CI 1.476-119.423; p=0.021). CONCLUSIONS: The prognosis of PLA appears to be dependent on underlying pathologies and severity of condition. More aggressive treatment should be considered if a poor prognosis is expected.

Septic Shock in Pyogenic Liver Abscess: Clinical Considerations / 대한소화기학회지

BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. METHODS: Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not. We reviewed the medical records including etiologies, underlying diseases, laboratory, radiologic and microbiologic findings, methods of treatment and treatment outcomes. RESULTS: The case fatality rate was 6.1%. In univariate analysis, the presence of general weakness, mental change, low platelet level, prolonged PT, high BUN level, high creatinine level, low albumin level, high AST level, high CRP level, abscess size >6 cm, the presence of gas-forming abscess, APACHE II score ≥20, and the presence of Klebsiella pneumoniae infection were significantly associated with septic shock. Multivariate analysis showed the presence of mental change (p=0.004), gas-forming abscess (p=0.012), and K. pneumoniae infection (p=0.027) were independent predictors for septic shock. CONCLUSIONS: The presence of mental change, gas-forming abscess, and K. pneumoniae infection were independent predictors for septic shock in patients with PLA.

Exploration of the safety of percutaneous puncture drainage for liver abscess in patients with blood coagulation dysfunction / 介入放射学杂志

Objective To discuss the safety of percutaneous puncture drainage for liver abscess in patients with blood coagulation dysfunction. Methods A total of 85 patients with liver abscess, who were admitted to authors’ hospital during the period from January 2013 to January 2014 to receive ultrasound-guided percutaneous puncture drainage, were included in this study. According to the international normalized ratio of prothrombin time≥1.5 and platelet count≤50 ×109/L, the patients were divided into group A (normal coagulation group,n=67) and group B (coagulation dysfunction group,n=18). The occurrence of postoperative complications was recorded and the results were compared between the two groups. Results In both groups, no statistically significant difference in hemoglobin level existed between preoperative level and postoperative one, and no bleeding complications occurred in all patients after the procedure. Conclusion For patients with liver abscess complicated by blood coagulation dysfunction, percutaneous puncture drainage treatment is safe and reliable.

Liver abscess and septic complications associated with advanced gastric cancer / 영남의대학술지

Pyogenic liver abscess with metastatic septic complications is a rare and serious infectious disease if not treated properly. Pyogenic liver abscesses are caused by bacterial, fungal, or parasitic organisms. Escherichia coli used to be the predominant causative agent, but Klebsiella pneumoniae emerged as a major cause in the 1990s. Liver abscesses are caused by hepatic invasion via many routes, such as, the biliary tree, portal vein, hepatic artery, direct extension, or penetrating trauma. Furthermore, diabetes mellitus and malignant conditions are established important risk factors of K. pneumoniae liver abscesses and of septic metastasis, and several recent studies have asserted that K. pneumoniae liver abscess might be a presentation of occult or silent colon cancer. We report a case of K. pneumoniae liver abscess, metastatic septic pulmonary embolism, and endophthalmitis associated with diabetes and advanced gastric cancer.