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Biliary diseases as main causes of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae.
- Source :
-
Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2017 May; Vol. 37 (5), pp. 727-734. Date of Electronic Publication: 2016 Oct 29. - Publication Year :
- 2017
-
Abstract
- Background & Aims: Little is known about aetiology and morbidity and clinical characteristics of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae.<br />Methods: An analysis between pyogenic liver abscess patients caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates and those caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae was performed.<br />Results: Among 817 pyogenic liver abscess patients, there were 176 patients (21.5%) with pyogenic liver abscess of biliary origin, and 67 pyogenic liver abscess patients (8.2%) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates (mainly Escherichia coli and Klebsiella pneumoniae). Of 176 pyogenic liver abscess patients related to biliary disorders, there were 48 pyogenic liver abscess patients (27.3%) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Within 67 pyogenic liver abscess patients caused by Enterobacteriaceae expressing extended-spectrum beta-lactamases, the occurrences of 48 pyogenic liver abscess patients (71.6%) were associated with biliary disorders. When compared with pyogenic liver abscess patients caused by non-extended-spectrum beta-lactamase-producing Enterobacteriaceae, there were significantly greater incidences of polymicrobial infections, bacteremia, pulmonary infection, recurrence and death in pyogenic liver abscess patients caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Carbapenems remain mainstay drugs against extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae. Independent risk factors for occurrence of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae were biliary disorders including extra- and intrahepatic cholangiolithiasis and an abnormal bilioenteric communication between bile and gut, a treatment history of malignancy such as operation and chemotherapy, pulmonary infection, and diabetes mellitus.<br />Conclusions: Pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae isolates mainly occurs in patients with biliary disorders or with a treatment history of malignancy. The mainstay of treatment remains carbapenems in combination with adequate aspiration or drainage.<br /> (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents therapeutic use
Carbapenems therapeutic use
China
Escherichia coli drug effects
Escherichia coli enzymology
Female
Humans
Klebsiella pneumoniae drug effects
Klebsiella pneumoniae enzymology
Liver Abscess, Pyogenic drug therapy
Logistic Models
Male
Middle Aged
Retrospective Studies
Young Adult
beta-Lactam Resistance
beta-Lactamases biosynthesis
Bile Duct Diseases complications
Escherichia coli isolation & purification
Klebsiella pneumoniae isolation & purification
Liver Abscess, Pyogenic etiology
Liver Abscess, Pyogenic microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1478-3231
- Volume :
- 37
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Liver international : official journal of the International Association for the Study of the Liver
- Publication Type :
- Academic Journal
- Accession number :
- 27718321
- Full Text :
- https://doi.org/10.1111/liv.13267