Klebsiella pneumoniae liver abscesses in a public hospital in Queens, New York

https://doi.org/10.1016/j.tmaid.2008.02.005Get rights and content

Summary

Background

Klebsiella pneumoniae liver abscess has been described frequently in patients residing in Asian countries. With the advent of immigration, this disease has become more common in certain hospitals in the United States, based upon the demographics of their patient populations.

Methods

We reviewed laboratory and clinical data for patients admitted to a municipal hospital in Queens, New York from 2000 to 2007 via a retrospective chart review.

Results

Of the 56 cases of pyogenic liver abscess reviewed, 20 cases were secondary to Klebsiella pneumoniae, verified via radiographic imaging plus positive blood culture or liver aspiration culture. Of these cases, 60% of patients were of Asian descent. Liver drainage appeared to be the most important modality of treatment. Choice of antibiotics and duration of treatment varied greatly depending upon whether an infectious disease consultant was called or not.

Conclusions

The majority of community-acquired Klebsiella pneumoniae liver abscess occurred in patients of Asian descent. Many of these patients have not resided in their country of origin for quite some time. In hospitals serving large Asian populations, this diagnosis must be considered and appropriate work-up for metastatic complications should be provided promptly.

Introduction

The epidemiology of pyogenic liver abscess has changed dramatically over the past century. Escherichia coli has been reported as the predominant bacterial cause of pyogenic liver abscess in the Western world.1 In the 1990s Klebsiella pneumoniae emerged as an important pathogen of pyogenic liver abscess. The proportion of pyogenic liver abscess caused by Klebsiella pneumoniae varies greatly depending upon which part of the world patients are from. Over the past 25 years in Taiwan, the percentage of pyogenic liver abscess cases with K. pneumoniae isolated from liver abscess ranges from 50% to 88%.2 As immigration has increased, certain cities in the United States are now exposed to more patients with K. pneumoniae liver abscess based upon the patient population that the hospital serves. Many of these patients present with similar symptoms, laboratory data, predisposing illnesses, and more importantly with similar ethnic backgrounds. A recent study conducted at Bellevue Hospital, New York and New York University Downtown Hospital located in the Chinatown district revealed that 41% of their pyogenic liver abscess cases were secondary to K. pneumoniae, with the majority of patients being of Asian descent.3 Other major case series from the United States since the 1970s have also found K. pneumoniae to be a significant pathogen of pyogenic liver abscess.

Pyogenic liver abscess is a potentially life-threatening disease, and diagnosis remains a major challenge, as symptoms are often non-specific. These patients are typically treated by drainage of the abscess and intravenous antibiotics. Percutaneous drainage is often the mode of choice for drainage. However, choice of antibiotics tends to vary widely, as well as length of treatment. We decided to review cases of K. pneumoniae liver abscess at Elmhurst Hospital in Queens, New York, which serves a diverse ethnic population of patients. Our interest was to see how these patients presented, their ethnic origin, and how they were managed.

Section snippets

Methods

Elmhurst Hospital is a 500-bed hospital in Queens, New York. It is a municipal hospital that provides medical care to the multi-ethnic borough of Queens.

We performed a retrospective analysis of all patients admitted to Elmhurst hospital from February 2000 until May 2007 with the discharge diagnosis via diagnosis-related group (DRG) of liver abscess. A total of 56 patients met this inclusion criterion based upon their discharge diagnosis from our computer system. Patients were included if the

Results

Fifty-six patients were diagnosed as having liver abscess when discharged from Elmhurst Hospital. Of these, 20 patients had liver abscess caused by K. pneumoniae, accounting for 35.7% of the total number of patients with liver abscess from February 2000 until May 2007. These 20 patients were included in our study, and their demographic data and clinical characteristics are shown in Table 1.

The mean age was 56.5 years. Fourteen (70%) were male. Twelve patients (60%) were of Asian descent and

Discussion

Our study of K. pneumoniae liver abscess in a municipal hospital in Queens, New York, has identified several interesting findings. Many of these findings are in concordance with recent findings from other Western countries. In our study, the mean age at presentation was 56.5 years, with a predominance of solitary, right-sided abscess, and relatively non-specific symptoms of fever, abdominal pain, and nausea. Several recent studies from Western and Asian countries have also shown a mean age of

References (31)

  • Chih-Jen Huang et al.

    Pyogenic hepatic abscess changing trends over 42 years

    Ann Surg

    (1996)
  • A. Ochsner et al.

    Pyogenic abscess of the liver

    Am J Surg

    (1938)
  • Jose Juan Ruiz-Hernandez et al.

    Pyogenic liver abscesses: mortality-related factors

    Eur J Gastroenterol Hepatol

    (2007)
  • W.M. Wong et al.

    Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period

    J Gastroenterol Hepatol

    (2002)
  • Shiuan-Chih Chen et al.

    Risk factors for developing metastatic infection from pyogenic liver abscesses

    Swiss Med Wkly

    (2006)
  • Cited by (73)

    • Endogenous endophthalmitis in Klebsiella pneumoniae pyogenic liver abscess: Systematic review and meta-analysis

      2020, International Journal of Infectious Diseases
      Citation Excerpt :

      Although Escherichia coli used to be the predominant pathogen, Klebsiella pneumoniae has emerged as the leading cause especially over the last three decades (Johannsen et al., 2000; Tsai et al., 2008; Qian et al., 2016). The disease variant known as K. pneumoniae pyogenic liver abscess (KPPLA) is particularly common in Taiwan (Tsai et al., 2008; Chen et al., 2016), China (Qian et al., 2016), South Korea (Chung et al., 2007; Yoon et al., 2014), and Singapore (Shelat et al., 2015) although cases have also been reported from other parts of the world (Rahimian et al., 2004; Pastagia and Arumugam, 2008). Not only does KPPLA presently comprise the majority of pyogenic liver abscesses in these regions, it also appears distinct from the pyogenic liver abscesses caused by other microorganisms in terms of clinical profile, underlying predisposing diseases (e.g., diabetes mellitus) and outcomes (Chen et al., 2007; Shelat et al., 2015).

    • Fluoroquinolones as an alternative treatment for Klebsiella pneumoniae liver abscess and impact on hospital length of stay

      2020, International Journal of Antimicrobial Agents
      Citation Excerpt :

      However, the total treatment duration in KPLA has not been determined; a treatment duration of 4–6 weeks was recommended by experts [8], and the duration of intravenous (i.v.) antibiotic therapy is ≥4 weeks [15]. Previous studies showed various durations of i.v. antibiotic therapy and hospital lengths of stay (LOS) of 2–5 weeks for KPLA [2,12–14,16,17]. The high bioavailability of oral fluoroquinolones has the potential to reduce the duration of i.v. antibiotic therapy in infectious diseases [18–20], but studies on fluoroquinolone use in KPLA are limited [16,21].

    View all citing articles on Scopus
    View full text