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Volume 42, Number 5, October 2009

Clinical and bacteriological characteristics of pyogenic liver abscess in non-diabetic patients


Han-Chuan Chuang, Te-Li Chen, Dung-Hung Chiang, Yi-Tzu Lee, Ling-Ju Huang, Fu-Der Wang, Chang-Phone Fung, Cheng-Yi Liu


Received: May 1, 2008    Revised: July 16, 2008    Accepted: August 25, 2008   

 

Corresponding author:

Chang-Phone Fung, Division of Infectectious, Department of Medicine, Taipei Veterans General Hospital, No. 201. Sec 2, Shih-Pai Rd, Taipei 11217, Taiwan. Email: cpfung@vghtpe.gov.tw



 

Background and purpose: 

Diabetes mellitus is an important risk factor for Klebsiella pneumoniae liver abscess, but many patients with pyogenic liver abscess (PLA) do not have diabetes. This study was conducted to compare the clinical characteristics and prognostic factors of K. pneumoniae PLA with that caused by other organisms in non-diabetic patients.



 

Methods:

The medical charts of patients with a diagnosis of PLA were retrospectively reviewed from January 2006 to December 2007. The clinical symptoms and signs, laboratory data, and risk factors were analyzed.



 

Results:

There were 50 patients in the K. pneumoniae group and 34 patients in the non-K. pneumoniae group had a higher prevalence of malignant disease than those in the K. pneumoniae group (58.8% vs 6.0%; p<0.001). Non-K. pneumoniae PLA was strongly associated with hepatobillary tumor (p=0.015). Among the non-K. pneumoniae isolates, Escherichia coli was the most common pathogen (n=20, 58.8%). Forty seven K. pneumoniae isolates (94%) were susceptible to all tested antimicrobial agents wxcept ampicillin, while the non-K. pneumoniae Gram-negative pathogens had greater resistance to first-generation cephalosporins. Poor prognostic factors included negative pathogens had greater resistance to first generation cephalosporins. Poor Prognostic  factor included  chronic renal failure (p=0.005), abscess rupture (p=0.0036), and right lower lung infitration (p=0.049).



 

Conclusion:

Hepatobiliary malignancy and newly diagnosed malignancy were risk factors for non-K. pneumoniae liver abscess in non-diabetic patients. Physicias should ascertain the presence of underlying malignancy in patients with non-K. pneumoniae  PLA.



 

Key words:

Diabets mellitus; Klebsiella pneumoniae; Liver abscess, pyogentic