Abstract
The pathogenic bacterium Klebsiella pneumoniae (KP) is the major causative agent of pyogenic liver abscess (PLA). But reports about the prognosis of KP-caused PLA (KPLA) are rare. This study aimed to ascertain the recurrence rate of KPLA after initial treatment and its contributing factors. A total of 110 patients who had first-time episodes of KPLA were included into the study. The average follow-up time was 3.65 ± 2.18 years. Twenty (18.18%) KPLA patients experienced recurrence. Those in the recurrence group had a significantly greater incidence of extended-spectrum β-lactamase (ESBL) production compared with the non-recurrence group (30.0% vs 8.89%, P = 0.018). Diabetes, biliary tract disease, and history of malignancy were not associated with recurrence (all P > 0.05). No difference in the CT characteristics of KPLA (including abscess size, location, whether multilocular, gas production of KPLA, and thrombophlebitis) was found between the two groups. Multivariate regression analysis showed that ESBL production (OR, 6.3; 95% CI, 1.02–38.59; P = 0.04) was an independent risk factor for the recurrence of KPLA. Our findings emphasize that KPLA has a high recurrence rate and ESBL production is an independent risk factor for recurrent KPLA.
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Abbreviations
- KP:
-
Klebsiella pneumoniae
- KPLA:
-
Klebsiella pneumoniae liver abscess
- PLA:
-
pyogenic liver abscess
- ESBL:
-
extended-spectrum β-lactamase
References
Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY (2012) Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis 12(11):881–887. https://doi.org/10.1016/S1473-3099(12)70205-0
Guo Y, Wang S, Zhan L, Jin Y, Duan J, Hao Z, Lv J, Qi X, Chen L, Kreiswirth BN, Wang L, Yu F (2017) Microbiological and clinical characteristics of hypermucoviscous Klebsiella pneumoniae isolates associated with invasive infections in China. Front Cell Infect Microbiol 7:24. https://doi.org/10.3389/fcimb.2017.00024
Kong H, Yu F, Zhang W, Li X (2017) Clinical and microbiological characteristics of pyogenic liver abscess in a tertiary hospital in East China. Medicine 96(37):e8050. https://doi.org/10.1097/md.0000000000008050
Liu C, Shi J, Guo J (2018) High prevalence of hypervirulent Klebsiella pneumoniae infection in the genetic background of elderly patients in two teaching hospitals in China. Infect Drug Resist 11:1031–1041. https://doi.org/10.2147/idr.S161075
Liu YC, Cheng DL, Lin CL (1986) Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med 146(10):1913–1916
Chang Z, Zheng J, Ma Y, Liu Z (2015) Analysis of clinical and CT characteristics of patients with Klebsiella pneumoniae liver abscesses: an insight into risk factors of metastatic infection. Int J Infect Dis 33:50–54. https://doi.org/10.1016/j.ijid.2014.12.041
Du ZQ, Zhang LN, Lu Q, Ren YF, Lv Y, Liu XM, Zhang XF (2016) Clinical characteristics and outcome of pyogenic liver abscess with different size: 15-year experience from a single center. Sci Rep 6:35890. https://doi.org/10.1038/srep35890
Jun JB (2018) Klebsiella pneumoniae liver Abscess. Infect Chemother 50(3):210–218. https://doi.org/10.3947/ic.2018.50.3.210
Dulku G, Mohan G, Samuelson S, Ferguson J, Tibballs J (2015) Percutaneous aspiration versus catheter drainage of liver abscess: a retrospective review. Australas Med J 8(1):7–18. https://doi.org/10.4066/AMJ.2015.2240
Zerem E, Omerovic S, Kunosic S (2014) Sonographically guided percutaneous treatment of liver abscesses in critically ill patients. J Clin Ultrasound 42(9):527–533. https://doi.org/10.1002/jcu.22190
Cheng HC, Chang WL, Chen WY, Kao AW, Chuang CH, Sheu BS (2008) Long-term outcome of pyogenic liver abscess: factors related with abscess recurrence. J Clin Gastroenterol 42(10):1110–1115. https://doi.org/10.1097/MCG.0b013e318157e4c1
Czerwonko ME, Huespe P, Bertone S, Pellegrini P, Mazza O, Pekolj J, de Santibanes E, Hyon SH, de Santibanes M (2016) Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes. HPB (Oxford) 18(12):1023–1030. https://doi.org/10.1016/j.hpb.2016.09.001
Chang Z, Gong Z, Zheng J, Ma Y, Liu Z (2016) Computed tomography features of septic pulmonary embolism caused by Klebsiella pneumoniae liver abscess associated with extrapulmonary metastatic infection. J Comput Assist Tomogr 40(3):364–369. https://doi.org/10.1097/rct.0000000000000383
Chang Z, Wang H, Li B, Liu Z, Zheng J (2018) Metabolic characterization of peripheral host responses to drainage-resistant Klebsiella pneumoniae liver abscesses by serum 1H-NMR spectroscopy. Front Cell Infect Microbiol 8:174. https://doi.org/10.3389/fcimb.2018.00174
Kim SH, Huh K, Cho SY, Kang CI, Chung DR, Peck KR (2019) Factors associated with the recurrence of acute pyelonephritis caused by extended-spectrum beta-lactamase-producing Escherichia coli: the importance of infectious disease consultation. Diagn Microbiol Infect Dis 94(1):55–59. https://doi.org/10.1016/j.diagmicrobio.2018.11.019
Zhang H, Yang Q, Liao K, Ni Y, Yu Y, Hu B, Sun Z, Huang W, Wang Y, Wu A, Feng X, Luo Y, Chu Y, Chen S, Cao B, Su J, Duan Q, Zhang S, Shao H, Kong H, Gui B, Hu Z, Badal R, Xu Y (2017) Update of incidence and antimicrobial susceptibility trends of Escherichia coli and Klebsiella pneumoniae isolates from Chinese intra-abdominal infection patients. BMC Infect Dis 17(1). https://doi.org/10.1186/s12879-017-2873-z
Chopra T, Marchaim D, Veltman J, Johnson P, Zhao JJ, Tansek R, Hatahet D, Chaudhry K, Pogue JM, Rahbar H, Chen TY, Truong T, Rodriguez V, Ellsworth J, Bernabela L, Bhargava A, Yousuf A, Alangaden G, Kaye KS (2012) Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli. Antimicrob Agents Chemother 56(7):3936–3942. https://doi.org/10.1128/AAC.05419-11
Chong Y, Shimoda S, Shimono N (2018) Current epidemiology, genetic evolution and clinical impact of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Infect Genet Evol 61:185–188. https://doi.org/10.1016/j.meegid.2018.04.005
Corbella M, Caltagirone M, Gaiarsa S, Mariani B, Sassera D, Bitar I, Muzzi A, Migliavacca R, Scudeller L, Stronati M, Cambieri P (2018) Characterization of an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit in Italy. Microb Drug Resist 24(8):1128–1136. https://doi.org/10.1089/mdr.2017.0270
Deng J, Li YT, Shen X, Yu YW, Lin HL, Zhao QF, Yang TC, Li SL, Niu JJ (2017) Risk factors and molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in Xiamen, China. J Glob Antimicrob Resist 11:23–27. https://doi.org/10.1016/j.jgar.2017.04.015
Turkel I, Yildirim T, Yazgan B, Bilgin M, Basbulut E (2018) Relationship between antibiotic resistance, efflux pumps, and biofilm formation in extended-spectrum beta-lactamase producing Klebsiella pneumoniae. J Chemother 30(6–8):354–363. https://doi.org/10.1080/1120009x.2018.1521773
Shi SH, Feng XN, Lai MC, Kong HS, Zheng SS (2017) Biliary diseases as main causes of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Liver Int 37(5):727–734. https://doi.org/10.1111/liv.13267
Yoon JH, Kim YJ, Kim SI (2019) Prognosis of liver abscess with no identified organism. BMC Infect Dis 19(1). https://doi.org/10.1186/s12879-019-4131-z
Liu JS, Lee CH, Chuah SK, Tai WC, Chang CC, Chen FJ (2019) Aspirin use is associated with reduced risk for recurrence of pyogenic liver abscess: a propensity score analysis. Sci Rep 9(1):11511. https://doi.org/10.1038/s41598-019-48017-3
Kim HY, Kim CW, Kim DR, Cho YW, Cho JY, Kim WJ, Choi HG (2017) Recurrent pyogenic liver abscess as a presenting manifestation of colorectal cancer. Korean J Intern Med 32(1):174–177. https://doi.org/10.3904/kjim.2015.301
Lai HC, Lin HC (2010) Cryptogenic pyogenic liver abscess as a sign of colorectal cancer: a population-based 5-year follow-up study. Liver Int 30(9):1387–1393. https://doi.org/10.1111/j.1478-3231.2010.02327.x
Mohan BP, Meyyur Aravamudan V, Khan SR, Chandan S, Ponnada S, Asokkumar R, Navaneethan U, Adler DG (2019) Prevalence of colorectal cancer in cryptogenic pyogenic liver abscess patients. Do they need screening colonoscopy? A systematic review and meta-analysis. Dig Liver Dis. https://doi.org/10.1016/j.dld.2019.08.016
Liao WI, Sheu WH, Chang WC, Hsu CW, Chen YL, Tsai SH (2013) An elevated gap between admission and A1C-derived average glucose levels is associated with adverse outcomes in diabetic patients with pyogenic liver abscess. PLoS One 8(5):e64476. https://doi.org/10.1371/journal.pone.0064476
Lin YT, Wang FD, Wu PF, Fung CP (2013) Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics. BMC Infect Dis 13:56. https://doi.org/10.1186/1471-2334-13-56
Wang HH, Tsai SH, Yu CY, Hsu HH, Liu CH, Lin JC, Huang GS, Cheng WT, Tung HJ, Chen CY, Chang WC (2014) The association of haemoglobin A(1)C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus. Eur Radiol 24(5):980–989. https://doi.org/10.1007/s00330-014-3113-1
Shi W, Zhou L, Peng X, Ren H, Wang Q, Shan F, Zhang Z, Liu L, Shi Y (2019) HIV-infected patients with opportunistic pulmonary infections misdiagnosed as lung cancers: the clinicoradiologic features and initial application of CT radiomics. J Thorac Dis 11(6):2274–2286. https://doi.org/10.21037/jtd.2019.06.22
Aboagye EO, Kraeber-Bodere F (2017) Highlights lecture EANM 2016: “embracing molecular imaging and multi-modal imaging: a smart move for nuclear medicine towards personalized medicine”. Eur J Nucl Med Mol Imaging 44(9):1559–1574. https://doi.org/10.1007/s00259-017-3704-6
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The study was supported by the National Natural Science Foundation of China (Grant No. 81901856) and the 345 Talent Project in Shengjing hospital of China Medical University.
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The Ethics Committee in Shengjing Hospital of China Medical University granted approval for this retrospective study, with a waiver of informed consent because the medical records of the subjects were de-identified to ensure patient confidentiality.
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Wang, H., Ren, Y., Chang, Z. et al. The increased recurrence rate of liver abscess caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 39, 1315–1320 (2020). https://doi.org/10.1007/s10096-020-03848-1
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DOI: https://doi.org/10.1007/s10096-020-03848-1