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Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess.

ABSTRACT: BACKGROUND:We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. METHODS:Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9?years. RESULTS:One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ? 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p?=?0.03 for Streptococcus milleri group, p?=?0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37-51?years) than those with PLA (median 68, IQR 50.5-78?years) (p?=?0.003) and all were male (9/9, 100%, (p?=?0.03)), with a history of recent travel in the majority (6/9, 66.7% (p?=?0.003)). C-reactive protein was higher in ALA than in PLA (p?=?0.06). In the entire cohort, loculation (HR?=?2.51 (95% CI 1.00-6.32), p?=?0.04) and baseline ALP (HR?=?4.78 (95% CI 1.19-19.2) per log10 increase, p?=?0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%. CONCLUSIONS:Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases.

SUBMITTER: Neill L

PROVIDER: S-EPMC6547479 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess.

Neill Lorna L Edwards Frances F Collin Simon M SM Harrington David D Wakerley Dominic D Rao Guduru Gopal GG McGregor Alastair C AC

BMC infectious diseases 20190603 1

<h4>Background</h4>We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality.<h4>Methods</h4>Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years.<h4>Results</h4>One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism wa ...[more]

PMID: 31159769

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Project description:ImportanceColorectal cancer (CRC) can compromise the mucosal barrier and subsequently allow a route for bacterial invasion into the portal system or systemic circulation. Despite preliminary data suggesting that patients who experienced pyogenic liver abscess (PLA) have higher CRC incidence rates, data from outside the Southeast Asian population are sparse.ObjectiveTo investigate whether there is an association between PLA and the subsequent incidence of diagnosed CRC using the Veterans Health Administration (VHA) cohort.Design, setting, and participantsA patient-level matched retrospective cohort study was conducted at 127 VHA hospitals across the US from January 1, 2003, to December 31, 2020. Patients were followed up to 10 years from PLA diagnosis. Data analysis was performed from April 14, 2002, to October 31, 2023. All patients who were admitted to VHA hospitals with a diagnosis of PLA were included. For each patient with PLA, up to 3 controls without diagnosis of PLA, matching age, sex, and health care facility, were selected.ExposurePyogenic liver abscess.Main outcomes and measuresThe primary outcome was CRC diagnosis during the follow-up period. A multivariable Fine-Gray subdistribution regression model with time-dependent coefficient was used to estimate the time-varying hazard ratio (HR) of CRC incidence while accounting for mortality as a competing event.ResultsA total of 8286 patients with PLA (male, 96.5%; mean [SD] age, 65.8 [11.9] years) and 23 201 patient-level matched controls (male, 96.3%; mean age, 65.3 [11.7] years) were included. A diagnosis of CRC was found in a significantly higher proportion of patients with PLA compared with controls (1.9% [159 of 8286] vs 0.8% [196 of 23 201]; P < .001). The incidence of CRC was significantly higher among patients with PLA during the first 3 years from PLA diagnosis (HR, 3.64; 95% CI, 2.70-4.91 at 0.5 years; HR, 2.51; 95% CI, 1.93-3.26 at 1 year; HR, 1.74; 95% CI, 1.33-2.28 at 2 years; and HR, 1.41; 95% CI, 1.05-1.89 at 3 years), but not significant after 3 years. This association was not observed among patients whose PLA was likely secondary to cholangitis or cholecystitis (HR, 1.78; 95% CI, 0.89-3.56 at 0.5 years).Conclusions and relevanceIn this patient-level matched retrospective cohort study, a significantly higher incidence of CRC was observed up to 3 years from PLA diagnosis. The findings suggest that offering CRC screening for patients with cryptogenic PLA may be useful, especially patients who have not been screened according to guidelines.

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Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess.

Publications

Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess.

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