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Meta-Analysis
. 2016 Oct;35(10):1557-65.
doi: 10.1007/s10096-016-2712-y. Epub 2016 Jul 11.

Distribution of common pathogens in patients with pyogenic liver abscess in China: a meta-analysis

M Luo  1 , X-X Yang  1 , B Tan  2 , X-P Zhou  1 , H-M Xia  3 , J Xue  1 , X Xu  1 , Y Qing  1 , C-R Li  1 , J-F Qiu  1 , Y-L Li  4
Affiliations
Meta-Analysis

Distribution of common pathogens in patients with pyogenic liver abscess in China: a meta-analysis

M Luo et al. Eur J Clin Microbiol Infect Dis. 2016 Oct.

Abstract

Pyogenic liver abscess (PLA) is a potentially life-threatening disease in many parts of the world, especially in Asia. The aim of this study was to quantify the proportion of common pathogens in patients with PLA in China, using a meta-analysis method based on systematic review of published studies. Several electronic databases were searched to identify the studies reporting the pathogens of PLA. We performed a meta-analysis to calculate the pooled proportion of pathogens and subgroup analysis among the included studies using R 3.1.1 software. In total, 183 studies were included in our final analysis, Klebsiella spp (54 %), Escherichia spp (29 %), Enterobacter spp (9 %), Proteus spp (6 %) and Pseudomonas spp (5 %) comprised the major gram-negative bacteria. Gram-positive bacteria mainly included Staphylococcus spp (13 %), Streptococcus spp (8 %) and Enterococcus spp (7 %). The distribution of pathogens in PLA patients were different in different economic regions in China. The proportion of Klebsiella spp had an upward tendency in recent years compared to other pathogens. In addition, the proportion of common pathogens in PLA patients with diabetes mellitus (DM) were carried out indicating that the dominant pathogens were Klebsiella spp (66 %), Escherichia spp (21 %) and Enterobacter spp (11 %). This meta-analysis showed that the main pathogens of PLA were Klebsiella spp, Escherichia spp, Staphylococcus spp, and Enterobacter spp in China. To ensure a precise estimate of the epidemiology of the pathogens, further large-scale or even a population-based study is needed.

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Conflict of interest statement

Compliance with ethical standards Funding The research leading to this manuscript has received funding from the National Natural Science Foundation of China (31200064). Conflict of interest None. Ethical approval Not required. Informed consent All authors approved the final version of the manuscript.

Figures

Fig. 1
Fig. 1
The PRISMA flowchart of the study identification and selection. PLA pyogenic liver abscess
Fig. 2
Fig. 2
The histogram of common pathogens in patients with pyogenic liver abscess
Fig. 3
Fig. 3
The Forest plot for the proportion of Klebsiella spp on different economic regions. The proportion of pathogens and its 95 % CIs were represented by a diamond and horizontal line in each study. Region A: Taiwan and Hong Kong, Region B: East economic region, Region C: Northeast economic region, Region D: Middle economic region, Region E: West economic region
Fig. 4
Fig. 4
The histogram of pathogens of pyogenic liver abscess in different economic regions. Region A: Taiwan and Hong Kong, Region B: East economic region, Region C: Northeast economic region, Region D: Middle economic region, Region E: West economic region
Fig. 5
Fig. 5
Change trend of pathogens of pyogenic liver abscess in recent years
Fig. 6
Fig. 6
Histogram of the common pathogens in PLA patients with DM. PLA pyogenic liver abscess, DM diabetes mellitus. The pooled proportion of the pathogens are shown in Figure 6, where the results have been calculated separately by meta-analysis methods with R 3.1.1 software
Fig. 7
Fig. 7
The Forest plot of sensitivity analysis of the proportion of Klebsiella spp. The pooled proportion of pathogens and its 95 % CIs were represented with a diamond and horizontal line
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