Print E-mail
Volume 41, Number 6, December 2008

Pyogenic liver abscess: clinical profile, microbiological characteristics, and management in a Hong Kong hospital


Ka-Ho Lok, Kam-Fu Li, Kin-Kong Li, Ming-Leung Szeto
Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong

Received: July 28, 2007    Revised: October 16, 2007    Accepted: January 31, 2008   

 

Corresponding author:

Dr. Ka-Ho Lok, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong. E-mail: Dr. Ka-Ho Lok This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

Pyogenic liver abscess (PLA) is a major hepatobiliary infection with a significant mortality rate of 10% to 25%. Over the past 2 decades, there have been significant developments in the management of this disease. This study describes the demographic, clinical, and microbiological features, management, and poor prognostic factors of PLA in Hong Kong.
 



 

Methods:

All patients with PLA admitted to the Tuen Mun Hospital, Hong Kong, from July 1998 to June 2004 were included. The medical records of eligible patients were reviewed to obtain demographic, clinical, laboratory, microbiological, and radiological data. Management strategies and factors associated with mortality were studied.



 

Results:

111 patients were included. Fever, chills, and right upper quadrant pain were the most common presenting symptoms. Low albumin level, elevated alkaline phosphatase, and leukocytosis were the most common laboratory features. Klebsiella spp. was the most common etiological agent detected in cultures of blood and abscess aspirates. Fifty two percent of these isolates were Klebsiella pneumoniae. Fifty three percent of PLA cases were cryptogenic in origin and 22.5% had underlying biliary pathology. The mortality rate was 11.7%. By multiple logistic regression analysis, hepato-pancreatico-biliary malignancy (p=0.001), requirement for open surgery (p=0.01), and significant delay in diagnosis (p=0.019) were independent risk factors associated with in-hospital mortality.



 

Conclusion:

Although advances in imaging and therapeutic modalities have lead to substantial improvement of outcomes, patients with underlying malignancy and those requiring open surgery in particular are at significant risk of mortality. Delay in diagnosis can result in a fatal outcome. A high index of suspicion with prompt institution of treatment is the cornerstone of successful treatment for patients with PLA.

 



 

Key words:

Asian continental ancestry group; Etiology; Liver abscess, pyogenic; Treatment outcome

 



 

J Microbiol Immunol Infect. 2008;41:483-490.