Clinical evolution of patients with hepatic abscesses in a period of 6 years (20002005)
Abstract number: P1626
Fernández I., López-Contreras J., Pericas R., Gurgui M., Sánchez F.
Objectives: Pyogenic liver abscesses are normally polimicrobial and caused by enteric bacteria. They can be associated with intestinal or biliary pathology but the 55% of them are cryptogenic.
Methods: Study:retrospective observational. Cases:in-patients diagnosed with hepatic abscess. Information: age, sex, risk factors, associated abdominal diseases, size, location, diagnosis method, isolated microorganism, type of treatment (antibiotics alone versus drainage plus antibiotics), antibiotic treatment duration and complications. Data were analysed with SPSS program for Windows. Stay days at Hospital and antibiotic treatment days were compared between the two groups: Group 1 patients managed only with antibiotic therapy and Group 2: patients managed with percutaneous or surgical drainage and systemic antibiotics. Because of the number of cases and the presence of outliers comparison between stay days and treatment days initially was done by Mann-Whitney test. After that t-test and Levene test were done excluding an outlier patient that had a 158 days of stay.
Results: 60 cases were detected, but only 50 had clinical diagnostic criteria.58% were male. Average age was 70 years old (3196). Risk factors: 66.7% diabetic, 22% underlying cancer and 32% biliary pathology.38% were cryptogenic. Thirty-seven cases (74%) were discreet abscesses. Most frequent localisation:right hepatic lobe (40%). Microbiologic diagnosis was done by fine needle aspiration (FNA) and blood culture in 17 cases (34%), only by FNA in 17 cases and only by blood culture in 3 cases. Microorganism were not isolated from 13 patients and diagnosis was asserted by clinical, analytical, radiological and evolution criteria. Nineteen cases (38%) were polymicrobial, most frequent microorganisms were: Escherichia coli, viridans group Streptococcus, Enterococcus and Bacteroides spp. Eighteen cases (36%) were monomicrobial, most frequent microorganisms were: viridans group Streptococcus and Escherichia coli. Complications: 22% had septic shock and attributable mortality was 6.3%. The most frequent empirical treatment was ceftriaxone plus metronidazole (46%) and the second was piperacillin-tazobactam (22%).
Conclusions: 1. Patients treated with antibiotics alone had shorter hospital stage, but no differences in antibiotic treatment duration were detected between the two groups. 2. Incidence of liver abscesses of unknown aetiology was lower than described previously in the literature. 3. Incidence of neoplasm as a risk factor was higher in our study.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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