Objective: Despite its high case-fatality risk, pyogenic liver abscess (PLA) lacks clear management guidelines in patients with negative microbial cultures. Our aim was to evaluate differences in clinical characteristics between patients with culture-negative liver abscess (CNLA) and those with culture-positive liver abscess (CPLA), and identify differences in the main causative pathogen.
Methods: In this study, we retrospectively collected medical records of PLA patients admitted to a teaching hospital from January 2010 to December 2019.
Results: In total, 324 PLA patients were enrolled in this study. Of these, 202 (62.3%) cases were confirmed cultural positive, including 109 patients (54%) and 20 (9.9%) patients infected with Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E.coli), respectively. Patients in the CPLA group were older (p=0.029) and had higher prevalence of abscesses larger than 5 cm in diameter (p = 0.003), gas-forming rate (p = 0.016), and percutaneous drainage (p < 0.001) compared with CNLA group. Patients with CPLA had significantly longer hospitalizations than those with CNLA (p = 0.010). Nevertheless, there was no significant difference in in-hospital mortality between the two groups (p = 0.415). Compared with patients with E. coli, those with K. pneumoniae had higher incidence of diabetes mellitus (p = 0.041), solitary abscess (p < 0.001), localization in the right hepatic lobe (p = 0.033), abscess size larger than 5 cm (p < 0.001) and percutaneous drainage (p = 0.002), but mortality was not significantly different (p = 1.000).
Conclusion: No significant difference in in-hospital mortality was found between patients with CNLA and those with CPLA group. However, clinical characteristics and management were different between the main causative pathogens, including K. pneumoniae and E. coli.

Keywords: PLA, culture negative, culture positive, Klebsiella pneumoniae, Escherichia coli


中文翻译：

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亚洲人群中培养阳性与培养阴性化脓性肝脓肿的人口统计学和临床​​结果

目的：尽管化脓性肝脓肿 (PLA) 的病死率很高，但在微生物培养阴性的患者中缺乏明确的管理指南。我们的目的是评估培养阴性肝脓肿 (CNLA) 患者和培养阳性肝脓肿 (CPLA) 患者的临床特征差异，并确定主要致病病原体的差异。
方法：在本研究中，我们回顾性收集了 2010 年 1 月至 2019 年 12 月期间在教学医院收治的 PLA 患者的病历。
结果：共有 324 名 PLA 患者被纳入本研究。其中，202例（62.3%）确诊为培养阳性，其中109例（54%）和20例（9.9%）肺炎克雷伯菌感染者( K. pneumoniae ) 和大肠杆菌( E.coli )，分别。与对照组相比，CPLA 组患者年龄更大 ( p =0.029)，脓肿直径大于 5 cm ( p = 0.003)、产气率 ( p = 0.016) 和经皮引流 ( p < 0.001) 的患病率更高CNLA 组。CPLA 患者的住院时间明显长于 CNLA 患者 ( p = 0.010)。然而，两组之间的院内死亡率没有显着差异 ( p = 0.415)。与大肠杆菌患者相比，肺炎克雷伯氏菌患者糖尿病 ( p = 0.041)、孤立性脓肿 ( p < 0.001)、位于肝右叶 ( p = 0.033)、脓肿大于 5 cm ( p < 0.001) 和经皮引流 ( p = 0.002)的发生率较高)，但死亡率没有显着差异 ( p = 1.000)。
结论： CNLA组与CPLA组患者院内死亡率无显着差异。然而，包括肺炎克雷伯菌和大肠杆菌在内的主要致病病原体的临床特征和管理有所不同。

关键词：PLA、培养阴性、培养阳性、肺炎克雷伯菌、大肠杆菌