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Therapeutic strategies for pyogenic liver abscess patients: a protocol proposed from the perspective of interventional radiologists

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Abstract

This review aims to compare the different therapeutic strategies for pyogenic liver abscess (PLA) patients, and a protocol for PLA treatment was proposed, which was based on current evidence from the literature. Data cited in this review were obtained primarily from Pubmed up to November, 2020. Articles were selected with the search items “pyogenic liver abscess”, “hepatic abscess”, “bacterial hepatic abscess”, “percutaneous drainage”, “treatment” and “therapy”. After the summary in the current literature, image-guided percutaneous drainage (PD) combined with antibiotics is recommended as first-line therapy despite lacking consensus on the therapeutic strategies. Surgery is generally performed when PLA fails to respond to PD, or the patient has concomitant abdominal diseases. Antibiotics are usually used prior to PD or surgery and the regime could be adjusted according to the blood or/and abscess culture results. When the PLA patients presented with Acute Physiologic and Chronic Health Evaluation II score > 15 points, ICU admission should be considered to reduce the mortality risk. A protocol for PLA treatment was proposed. However, the accuracy of the proposed protocol should be validated in the further studies.

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References

  1. Jepsen P, Vilstrup H, Schonheyder HC, Sorensen HT. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977–2002. Aliment Pharmacol Ther. 2005;21:1185–8.

    Article  CAS  PubMed  Google Scholar 

  2. Meddings L, Myers RP, Hubbard J, Shaheen AA, Laupland KB, Dixon E, et al. A population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol. 2010;105:117–24.

    Article  PubMed  Google Scholar 

  3. Tsai FC, Huang YT, Chang LY, Wang JT. Pyogenic liver abscess as endemic disease. Taiwan Emerg Infect Dis. 2008;14:1592–600.

    Article  PubMed  Google Scholar 

  4. Lee KT, Wong SR, Sheen PC. Pyogenic liver abscess: an audit of 10 years’ experience and analysis of risk factors. Dig Surg. 2001;18(459–65):465–6.

    Google Scholar 

  5. Cerwenka H. Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol. 2010;16:2458–62.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Popescu A, Sporea I, Sirli R, Danila M, Mare R, Gradinaru M, et al. Does Contrast Enhanced Ultrasound improve the management of liver abscesses? A single centre experience. Med Ultrason. 2015;17:451–5.

    PubMed  Google Scholar 

  7. Mcfadzean AJ, Chang KP, Wong CC. Solitary pyogenic abscess of the liver treated by closed aspiration and antibiotics; a report of 14 consecutive cases with recovery. Br J Surg. 1953;41:141–52.

    Article  CAS  PubMed  Google Scholar 

  8. Van der Spek P, Peters O, Claes H, Devis G. Percutaneous catheter drainage of solitary pyogenic liver abscess. Acta Clin Belg. 1984;39:363–7.

    Article  PubMed  Google Scholar 

  9. Andersson R, Forsberg L, Hederstrom E, Hochbergs P, Bengmark S. Percutaneous management of pyogenic hepatic abscesses. HPB Surg. 1990;2:185–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Tazawa J, Sakai Y, Maekawa S, Ishida Y, Maeda M, Marumo F, et al. Solitary and multiple pyogenic liver abscesses: characteristics of the patients and efficacy of percutaneous drainage. Am J Gastroenterol. 1997;92:271–4.

    CAS  PubMed  Google Scholar 

  11. Giorgio A, de Stefano G, Di Sarno A, Liorre G, Ferraioli G. Percutaneous needle aspiration of multiple pyogenic abscesses of the liver: 13-year single-center experience. AJR Am J Roentgenol. 2006;187:1585–90.

    Article  PubMed  Google Scholar 

  12. Ahmed S, Chia CL, Junnarkar SP, Woon W, Shelat VG. Percutaneous drainage for giant pyogenic liver abscess–is it safe and sufficient? Am J Surg. 2016;211:95–101.

    Article  PubMed  Google Scholar 

  13. Liao WI, Tsai SH, Yu CY, Huang GS, Lin YY, Hsu CW, et al. Pyogenic liver abscess treated by percutaneous catheter drainage: MDCT measurement for treatment outcome. Eur J Radiol. 2012;81:609–15.

    Article  PubMed  Google Scholar 

  14. Xu S, Shi BQ, Chao LM, Tan YS, Zhang XJ. Prognostic nomogram for the combination therapy of percutaneous catheter drainage and antibiotics in pyogenic liver abscess patients. Abdom Radiol (NY). 2020;45:393–402.

    Article  Google Scholar 

  15. Rajak CL, Gupta S, Jain S, Chawla Y, Gulati M, Suri S. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol. 1998;170:1035–9.

    Article  CAS  PubMed  Google Scholar 

  16. Yu SC, Ho SS, Lau WY, Yeung DT, Yuen EH, Lee PS, et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatology. 2004;39:932–8.

    Article  PubMed  Google Scholar 

  17. Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol. 2007;189:W138–42.

    Article  PubMed  Google Scholar 

  18. Singh O, Gupta S, Moses S, Jain DK. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses. Indian J Gastroenterol. 2009;28:88–92.

    Article  PubMed  Google Scholar 

  19. Ahmed M, Alam J, Hussain S, Aslam M. Prospective randomized comparative study of percutaneous catheter drainage and percutaneous needle aspiration in the treatment of liver abscess. ANZ J Surg. 2020. https://doi: 10.1111/ans.16461.(published online ahead of print, 2020 Nov 26).

  20. Tan YM, Chung AY, Chow PK, Cheow PC, Wong WK, Ooi LL, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm. Ann Surg. 2005;241:485–90.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lai KC, Cheng KS, Jeng LB, Huang CC, Lee YT, Chang HR, et al. Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer. Am J Surg. 2013;205:52–7.

    Article  PubMed  Google Scholar 

  22. Mezhir JJ, Fong Y, Jacks LM, Getrajdman GI, Brody LA, Covery AM, et al. Current management of pyogenic liver abscess: surgery is now second-line treatment. J Am Coll Surg. 2010;210:975–83.

    Article  PubMed  Google Scholar 

  23. Liu CH, Gervais DA, Hahn PF, Arellano RS, Uppot RN, Mueller PR. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009;20:1059–65.

    Article  PubMed  Google Scholar 

  24. Sugiyama M, Atomi Y. Pyogenic hepatic abscess with biliary communication. Am J Surg. 2002;183:205–8.

    Article  PubMed  Google Scholar 

  25. Lo JZ, Leow JJ, Ng PL, Lee HQ, Mohd Noor NA, Low JK. Predictors of therapy failure in a series of 741 adult pyogenic liver abscesses. J Hepatobiliary Pancreat Sci. 2015;22:156–65.

    Article  PubMed  Google Scholar 

  26. Du ZQ, Zhang LN, Lu Q, Ren YF, Lv Y, Liu XM. Clinical charateristics and outcome of pyogenic liver abscess with different size: 15-year experience from a single center. Sci Rep. 2016;6:35890.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Thng CB, Tan YP, Shelat VG. Gas-forming pyogenic liver abscess: a world review. Ann Hepatobiliary Pancreat Surg. 2018;22:11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chou FF, Sheen-Chen SM, Chen YS, Lee TY. The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess. Arch Surg. 1995;130(401–5):406.

    Google Scholar 

  29. Chen SC, Tsai SJ, Chen CH, Huang CC, Lin DB, Wang PH, et al. Predictors of mortality in patients with pyogenic liver abscess. Neth J Med. 2008;66:196–203.

    CAS  PubMed  Google Scholar 

  30. Lee HL, Lee HC, Guo HR, Ko WC, Chen KW. Clinical significance and mechanism of gas formation of pyogenic liver abscess due to Klebsiella pneumoniae. J Clin Microbiol. 2004;42:2783–5.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wang HH, Tsai SH, Yu CY, Hsu HH, Liu CH, Lin JC, et al. The association of haemoglobin A(1)C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus. Eur Radiol. 2014;24:980–9.

    Article  PubMed  Google Scholar 

  32. Barnes PF, De Cock KM, Reynolds TN, Ralls PW. A comparison of amebic and pyogenic abscess of the liver. Medicine (Baltimore). 1987;66:472–83.

    Article  CAS  Google Scholar 

  33. Brunetti E, Capellini R, Meloni C, Bruno R, Zanardini T, et al. The value of culture of pus via percutaneous drainage under sonographic guidance in diagnosis and therapy of pyogenic liver abscess. Int J Antimicrob Agents. 1995;6:81–3.

    Article  CAS  PubMed  Google Scholar 

  34. Hope WW, Vrochides DV, Newcomb WL, Mayo-Smith WW, Lannitti DA. Optimal treatment of hepatic abscess. Am Surg. 2008;74:178–82.

    Article  PubMed  Google Scholar 

  35. Chung YF, Tan YM, Lui HF, Tay KH, Lo RH, Kurup A, et al. Management of pyogenic liver abscesses - percutaneous or open drainage? Singapore Med J. 2007;48(1158–65):1165.

    Google Scholar 

  36. Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26:1434–8.

    Article  CAS  PubMed  Google Scholar 

  37. Solomkin JS, Reinhart HH, Dellinger EP, Bohnen JM, Rotstein OD, Vogel SB, et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Ann Surg 1996;223:303–15.

  38. Ng FH, Wong WM, Wong BC, Kng C, Wong SY, Lai KC, et al. Sequential intravenous/oral antibiotic vs. continuous intravenous antibiotic in the treatment of pyogenic liver abscess. Aliment Pharmacol Ther 2002;16:1083–90.

  39. Gao HN, Yuan WX, Yang MF, Zhao H, Hu JH, Zhang X, et al. Clinical significance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess. World J Gastroenterol. 2010;16:4871–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Law ST, Li KK. Role of C-reactive protein in response-guided therapy of pyogenic liver abscess. Eur J Gastroenterol Hepatol. 2014;26:179–86.

    Article  CAS  PubMed  Google Scholar 

  41. Levin DC, Eschelman D, Parker L, Rao VM. Trends in use of percutaneous versus open surgical drainage of abdominal abscesses. J Am Coll Radiol. 2015;12:1247–50.

    Article  PubMed  Google Scholar 

  42. Seeto RK, Rockey DC. Pyogenic liver abscess Changes in etiology, management, and outcome. Medicine (Baltimore) 1996;75:99–113.

  43. Chu KM, Fan ST, Lai EC, Lo CM, Wong J. Pyogenic liver abscess. An audit of experience over the past decade. Arch Surg 1996;131:148–52.

  44. Barakate MS, Stephen MS, Waugh RC, Gallagher PJ, Solomon MJ, Storey DW, et al. Pyogenic liver abscess: a review of 10 years’ experience in management. Aust N Z J Surg. 1999;69:205–9.

    Article  CAS  PubMed  Google Scholar 

  45. Herman P, Pugliese V, Montagnini AL, Salem MZ, Machado MA, Da Cunha JE, et al. Pyogenic liver abscess: the role of surgical treatment. Int Surg. 1997;82:98–101.

    CAS  PubMed  Google Scholar 

  46. Hsieh HF, Chen TW, Yu CY, Wang NC, Chu HC, Shih ML, et al. Aggressive hepatic resection for patients with pyogenic liver abscess and APACHE II score > or =15. Am J Surg. 2008;196:346–50.

    Article  PubMed  Google Scholar 

  47. Wang W, Lee WJ, Wei PL, Chen TC, Huang MT. Laparoscopic drainage of pyogenic liver abscesses. Surg Today. 2004;34:323–5.

    Article  PubMed  Google Scholar 

  48. Tu JF, Huang XF, Hu RY, You HY, Zheng XF, Jiang FZ. Comparison of laparoscopic and open surgery for pyogenic liver abscess with biliary pathology. World J Gastroenterol. 2011;17:4339–43.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Liu L, Chen W, Lu X, Zhang K, Zhu C. Pyogenic Liver abscess: a retrospective study of 105 cases in an emergency department from east China. J Emerg Med. 2017;52:409–16.

    Article  PubMed  Google Scholar 

  50. Chen W, Chen CH, Chiu KL, Lai HC, Liao KF, Ho YJ. Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care. Crit Care Med. 2008;36:1184–8.

    Article  PubMed  Google Scholar 

  51. Verlenden WR, Frey CF. Management of liver abscess. Am J Surg. 1980;140:53–9.

    Article  PubMed  Google Scholar 

  52. Chen YC, Lin CH, Chang SN, Shi ZY. Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000–2011. J Microbiol Immunol Infect. 2016;49:646–53.

    Article  PubMed  Google Scholar 

  53. LeGall JR, Loirat P, Alperovitch A. APACHE II–a severity of disease classification system. Crit Care Med. 1986;14:754–5.

    Article  CAS  PubMed  Google Scholar 

  54. Hsieh CB, Tzao C, Yu CY, Chen CJ, Chang WK, Chu CH, et al. APACHE II score and primary liver cancer history had risk of hospital mortality in patients with pyogenic liver abscess. Dig Liver Dis. 2006;38:498–502.

    Article  PubMed  Google Scholar 

  55. Kuo SH, Lee YT, Li CR, Tseng CJ, Chao WN, Wang PH, et al. Mortality in Emergency Department Sepsis score as a prognostic indicator in patients with pyogenic liver abscess. Am J Emerg Med. 2013;31:916–21.

    Article  PubMed  Google Scholar 

  56. Chen SC, Huang CC, Tsai SJ, Yen CH, Lin DB, Wang PH, et al. Severity of disease as main predictor for mortality in patients with pyogenic liver abscess. Am J Surg. 2009;198:164–72.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdansantiao Street, Dongcheng District, Beijing, 100730, China

    Sheng Xu & Xiao-Guang Li

  2. Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 1 Dahua Street, Dongcheng District, Beijing, 100370, China

    Sheng Xu, Zhi-Xin Bie, Yuan-Ming Li, Bin Li & Xiao-Guang Li

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  1. Sheng Xu
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  2. Zhi-Xin Bie
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  3. Yuan-Ming Li
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  4. Bin Li
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Sheng Xu has drafted this review, Zhi-Xin Bie and Yuan-Ming Li have searched the literature, Bin-Li has formulated the tables and figures, Xiao-Guang Li has designed this review and revised the manuscript. All authors have admitted Xiao-Guang Li as the corresponding author.

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Correspondence to Xiao-Guang Li.

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Xu, S., Bie, ZX., Li, YM. et al. Therapeutic strategies for pyogenic liver abscess patients: a protocol proposed from the perspective of interventional radiologists. Chin J Acad Radiol 4, 41–47 (2021). https://doi.org/10.1007/s42058-021-00060-8

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