Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital

Abstract

Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.

Figure 1

Overview of the search strategy and the patients included in the study (HIS hospital information system, PACS picture archiving and communication system, ICD-10 10th version of the international statistical classification of diseases and related health problems).

Figure 2

Comorbidities of patients with pyogenic liver abscess.

Figure 3

Diagnostic tree confirming diagnoses of pyogenic liver abscess in the study population (CT computed tomography, US ultrasound, MRI magnetic resonance imaging, PET positron emission tomography).

Figure 4

Therapeutic cascade in the treatment of patients with pyogenic liver abscess.

Figure 5

Sunburst chart showing all-cause survival ratios 30 days after diagnosis of pyogenic liver abscess as a function of blood and abscess culture results. When interpreting the diagram, it is important to note that a semicircle (in blue and red tones, respectively) in each case reflects the whole collective (100%) of PLA patients.

Figure 6

Kaplan–Meier curves along with their 95% confidence bands for patients with pyogenic liver abscesses divided with respect to underlying malignancies (top), Candida spp. (center) and Enterobacterales (bottom).