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Clinical Characteristics of Pyogenic Liver Abscess with Klebsiella pneumoniae orNon-Klebsiella pneumoniae and Its Prognosis Associated with Diabetes Mellitus
Seong Ill Woo, M.D.1, Hyeok Choon Kwon, M.D.1, Young Hwa Choi, M.D.1,7, Seung Soo Shin, M.D.Chang Oh Kim, M.D.2,7, Hyo Youl Kim, M.D.3,7, Yoon Seon Park, M.D.2,7, Yoon Soo Park, M.D.2,7 Young Goo Song, M.D.2,7, Joon Sup Yeom, M.D.4,7, Hee Jung Yoon, M.D
1Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea3Department of Internal Medicine, Yonsei University, Wonju College
Vol.38 Num.2 (p77~84)
Background:Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes.
Materials and Methods:We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively.
Results:Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and ?-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy.
Conclusion:The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Keywords : Liver abscess, Diabetes Mellitus, Klebsiella pneumoniae