Pyogenic liver abscess: Clinical features and microbiological profiles in tertiary care center

Shyam K Kumar; Naz Perween; Balram J Omar; Ashish Kothari; Akash T Satsangi; Mithilesh K Jha; Aroop Mohanty

doi:10.4103/jfmpc.jfmpc_927_20

Pyogenic liver abscess: Clinical features and microbiological profiles in tertiary care center

J Family Med Prim Care. 2020 Aug 25;9(8):4337-4342. doi: 10.4103/jfmpc.jfmpc_927_20. eCollection 2020 Aug.

Authors

Shyam K Kumar¹, Naz Perween², Balram J Omar¹, Ashish Kothari¹, Akash T Satsangi³, Mithilesh K Jha¹, Aroop Mohanty¹

Affiliations

¹ Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
² Department of Microbiology, Superspeciality Paediatric Hospital and Postgraduate Teaching Institute, Noida, Uttar Pradesh, India.
³ Department of Biotechnology, School of Engineering and Science, Sharda University, Noida, Uttar Pradesh, India.

Abstract

Background: Pyogenic liver abscess (PLA) is the end result of a number of pathologic processes that cause a suppurative infection of the liver parenchyma.

Materials and methods: Sixty-five patients of age more than 18 years and radiologically confirmed cases of liver abscess were included in this study. Pus and blood samples were collected. Pus was processed for microscopy of trophozoite of Entamoeba histolytica and aerobic and anaerobic bacterial culture. Blood was processed for antibody ELISA for Entamoeba histolytica and aerobic bacterial culture. Identification of aerobic and anaerobic isolates was done by Vitek2 and antibiotic sensitivity test for aerobic bacterial isolates was done by Vitek2.

Result: Out of sixty five, twenty five were confirmed as PLA. All patients were male with mean age 37.9 years. Fever and upper abdominal pain were the most common symptoms. Right lobe comprised 80% of the abscess. Pus sample was more sensitive than blood sample for diagnosis. There were a total of 33 isolates in our study. Klebsiella pneumoniae (6/33) was the most common aerobic isolate and Clostridium spp. (7/33) was the anaerobic isolate. All gram-negative bacteria were showing good sensitivity for 3^rd and 4^th generation cephalosporins, fluoroquinolones, amikacin, gentamicin, piperacillin-tazobactam, imipenem and meropenem. Abscess >5 cm was treated with percutaneous drainage while abscess <5 cm was treated with antibiotics only.

Conclusion: Diagnosis should be made with the combination of clinical suspicion, radiology, and microbiology. Empirical therapy should include anaerobic coverage too. Only antibiotic therapy can be given under consideration of size of abscess, persistence of fever after giving antibiotics, and any suspected complications.

Keywords: Anaerobe; pyogenic liver abscess; right lobe.