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Predictors of therapy failure in a series of 741 adult pyogenic liver abscesses
Author(s) -
Lo Joseph Zhi Wen,
Leow Jeffrey Jia Jun,
Ng Perryn Ling Fei,
Lee Hui Qi,
Mohd Noor Nor Alia,
Low Jee Keem,
Junnarkar Sameer P.,
Woon Winston Wei Liang
Publication year - 2015
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.174
Subject(s) - series (stratigraphy) , medicine , liver failure , intensive care medicine , biology , paleontology
Background Adult pyogenic liver abscess ( PLA ) is a major hepato‐biliary infection. We aim to identify risk factors associated with therapy failure. Methods Retrospective study of 741 PLA patients (2001–2011) and comparison with earlier data (1994–1997). Risk factors associated with therapy failure were identified with multivariate analysis. Results Incidence of PLA is 86/100 000 admissions, with average size 5.75 cm. 68% of PLA were secondary to K lebsiella pneumoniae and there is increasing extended‐spectrum beta‐lactamase ( ESBL ) resistance. Compared with 1990s, there is an increasing annual incidence (from 18 to 67). Elderly age (≥55‐years‐old), presence of multiple abscesses, malignancy as etiology and patients who underwent endoscopic intervention are independent predictors for failure of antibiotics‐only therapy while average intravenous antibiotics duration and average abscess size are not. ECOG performance status ≥2, pre‐existing hypertension and hyperbilirubinaemia are independent predictors for failure of percutaneous therapy while the presence of multiple abscesses and average abscess size are not. Conclusion There is an increasing PLA incidence with increasing ESBL resistance. Percutaneous drainage should be considered early for elderly patients (≥55‐years‐old), with multiple abscesses, malignancy as etiology or who required endoscopic intervention. We should have a low threshold for surgical intervention for patients with ECOG performance status ≥2, co‐morbidity of hypertension or hyperbilirubinaemia.