ABSTRACT
Pyogenic liver abscesses are relatively rare in developed countries such as the United States, and, when they do occur, they are typically secondary to direct or hematogenous spread of intra-abdominal pathologies. Gastrointestinal pathogens such as Escherichia coli and Enterococcus species are typically implicated. Conversely, the Streptococcus viridans group is a rare cause of bacteremia and abscess formation, especially in immunocompetent patients. We present a case of a 53-year-old male who presented with S. viridans liver abscess that was found to be secondary to a swallowed dental bridge that was lodged in the patient's descending colon. The patient was treated with intravenous antibiotics, percutaneous drainage, and colonoscopy for removal of the foreign body; the patient had a good response to treatment and was discharged on oral antibiotics. In any patient who has fever and abnormal liver function tests, hepatobiliary sepsis including liver abscess should always be excluded. Additionally, it is important to suspect unusual pathogens and sources of infection. We suggest empiric broad-spectrum antibiotic coverage when liver abscess is suspected and tailoring treatment as the specific organism and susceptibilities are identified. Moreover, we suggest the importance of removing any foreign bodies promptly upon discovery as they may serve as an important nidus of infection.
ABSTRACT
Background The opioid crisis in the United States of America has been worsening due to previous sharp increases in opioid prescriptions and a lack of resources available to those affected. Emergency departments (ED) across the nation have been exhausted with a constant influx of patients related to opioid-related issues. Because of limited resources, it is crucial to efficiently distribute rehabilitation and mental wellness efforts amongst those most susceptible to opioid abuse. By identifying common environments and characteristics of the population presenting to ED's for opioid-related issues, we can (1) lessen the economic burden on the healthcare system while (2) increasing the rate of successful treatment for those affected by opioid addiction. Methods Data was obtained regarding ED visits for opioid-related issues at the level of all 50 states from the Healthcare Cost and Utilization Project's (HCUP) State Emergency Department Databases (SEDD) and nationally from the Nationwide Emergency Department Sample (NEDS). Rates of ED admissions for opioid-related issues were statistically analyzed to identify characteristics of the population that are most at risk for presenting to the ED for opioid-related issues. Results Statistical analysis showed residents of Large Metropolitan areas (M=351.94, p=0.022, CI±42.89), those earning incomes below the 25th percentile (M=359.14, p=0.008, CI ±61.39), and 25-44-year-old population (M=456.71, p=0.001, CI±27.01) to be the most likely subset of the population to report to the ED for opioid-use issues. Conversely, those earning incomes above the 75th percentile were significantly less likely to utilize ED's for opioid-related issues (M=143.10, p=0.026, CI±0.026). Conclusion Results demonstrated that patients between the ages of 25 and 44 were more likely to develop opioid use disorders. This provides an opportunity to educate this population via opioid education centers. Additionally, residents of Large Metropolitan areas would benefit from naloxone distribution centers. Lastly, higher income levels appear to be related to a decrease in ED presentation for opioid abuse. This provides evidence for medication-assisted therapy (MAT) to be provided by low-income insurance plans.
