Klebsiella pneumoniae liver abscesses in a public hospital in Queens, New York
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
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2020, International Journal of Infectious DiseasesCitation 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 AgentsCitation 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].