![]() ![]() ![]() The diagnosis of pyogenic liver abscess was based upon clinical features, evidence from imaging studies (ultrasound or computed tomography), as well as microbiology (blood or aspirate culture results). A total of 63 patients were identified during the study period of August 1998 to November 2008. ![]() This data was augmented with data from individual (upper gastrointestinal) surgeons’ databases to ensure that all possible treated patients during the study period were captured. A list of patients was generated by accessing the ICD-10 codes of the hospital admissions database, which dated back to 1996. In addition, we aim to investigate the risk factors associated with failure of initial percutaneous therapy.Ī retrospective study of all patients treated at Royal North Shore and affiliated hospitals for pyogenic liver abscesses was conducted. This contrasts with the predominance of Escherichia coli pyogenic liver abscesses of biliary aetiology found in Western institutions.Ĭontinued changes to the management and aetiology of this disease entity prompted us to review it and describe our own experience with pyogenic liver abscesses over the past 10 years. These abscesses are typically associated with diabetes or a cryptogenic aetiology. Many of the recent large case series are from South East Asian institutions, where a large proportion of pyogenic liver abscesses are caused by Klebsiella pneumoniae. Surgical management is increasingly limited to cases of failed radiological management or to the management of complications.įurthermore, there is an increasing recognition that pyogenic liver abscesses seen in Western and Asian countries differ in demographic characteristics, aetiological factors, and clinical behaviour. However, there appears to be an overall trend for antibiotics and radiological intervention (either drainage or aspiration) to be the initial treatment of choice. Depending on the cause and local expertise, a varying proportion of patients are treated with antibiotics alone, surgical therapy or radiological intervention, or a combination of the above. The management of pyogenic liver abscesses is changing. Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs However, a small proportion of patients still require surgical drainage. Serum hypoalbuminaemia on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.ĬONCLUSION: PLA is a diagnostic challenge, because the presentation of this condition is non-specific. 17% underwent surgical management during their hospitalization. The initial procedure was radiological aspiration ± drainage in 54 and surgery in two patients. Four patients died in this series: one from sepsis, two from advanced cancer, and one from acute myocardial infarction. A presumptive cryptogenic cause was most common (34%). Causative organisms were: Streptococcus milleri 25%, Klebsiella pneumoniae 21%, and Escherichia coli 16%. 67% of patients had a solitary abscess, while 32% had > 3 abscesses with a median (IQR) diameter of 6.3 (4-9) cm. Liver function tests were non-specifically abnormal. Only 59% of patients were febrile at presentation however, the serum C-reactive protein was elevated in all 47 in whom it was measured. RESULTS: Sixty-three patients (42 males, 21 females) aged 65 (± 14) years had prodromal symptoms for a median (interquartile range IQR) of 7 (5-14) d. Demographic, clinical, radiological, and microbiological characteristics, as well as surgical/radiological interventions, were recorded. ![]() Amoebic and hydatid abscesses were excluded. METHODS: A retrospective study of records of 63 PLA patients presenting between 19 to Australian tertiary referral centre, were reviewed. AIM: To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy. ![]()
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