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Biliary diseases as main causes of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae
Author(s) -
Shi ShaoHua,
Feng XiaoNing,
Lai MingChun,
Kong HaiShen,
Zheng ShuSen
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13267
Subject(s) - pyogenic liver abscess , klebsiella pneumoniae , enterobacteriaceae , liver abscess , medicine , abscess , gastroenterology , microbiology and biotechnology , escherichia coli , surgery , biology , biochemistry , gene
Background & Aims Little is known about aetiology and morbidity and clinical characteristics of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Methods An analysis between pyogenic liver abscess patients caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates and those caused by non‐extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae was performed. Results Among 817 pyogenic liver abscess patients, there were 176 patients (21.5%) with pyogenic liver abscess of biliary origin, and 67 pyogenic liver abscess patients (8.2%) caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates (mainly Escherichia coli and Klebsiella pneumoniae ). Of 176 pyogenic liver abscess patients related to biliary disorders, there were 48 pyogenic liver abscess patients (27.3%) caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Within 67 pyogenic liver abscess patients caused by Enterobacteriaceae expressing extended‐spectrum beta‐lactamases, the occurrences of 48 pyogenic liver abscess patients (71.6%) were associated with biliary disorders. When compared with pyogenic liver abscess patients caused by non‐extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae, there were significantly greater incidences of polymicrobial infections, bacteremia, pulmonary infection, recurrence and death in pyogenic liver abscess patients caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Carbapenems remain mainstay drugs against extended‐spectrum beta‐lactamase‐producing E. coli and K. pneumoniae . Independent risk factors for occurrence of pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae were biliary disorders including extra‐ and intrahepatic cholangiolithiasis and an abnormal bilioenteric communication between bile and gut, a treatment history of malignancy such as operation and chemotherapy, pulmonary infection, and diabetes mellitus. Conclusions Pyogenic liver abscess caused by extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae isolates mainly occurs in patients with biliary disorders or with a treatment history of malignancy. The mainstay of treatment remains carbapenems in combination with adequate aspiration or drainage.