Skip to main content

Advertisement

SpringerLink
Log in

A retrospective study of pyogenic liver abscess caused primarily by Klebsiella pneumoniae vs. non-Klebsiella pneumoniae: CT and clinical differentiation

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The incidence of Klebsiella pneumoniae pyogenic liver abscesses (KP-PLA) is increasing. However, its diagnosis and treatment are often delayed, leading to complications. In this study, we aimed to retrospectively compare computed tomographic (CT) features of KP-PLAs with those of abscesses caused by other bacterial pathogens (non-KP-PLAS) and to further identify prognostic factors for PLA.

Methods

Data of 219 study patients including clinical presentation, comorbid conditions, metastatic infection, treatment duration, and mortality were retrospectively collated. CT characteristics of abscesses were recorded. Etiology was established by pus and/or blood culture. The differentiating CT features and clinical findings were compared between the monomicrobial KP-PLA and non-KP-PLA groups. Furthermore, factors related to in-hospital case fatality were analyzed.

Results

Multivariate analysis identified thin-walled abscesses, absent rim enhancement, metastatic infection, and absence of underlying biliary tract disease as significant predictors of KP-PLA. With 3/4 criteria applied in combination, a specificity of 96.5% was achieved for KP-PLA diagnosis. The in-hospital mortality rate was 3.7%. Multivariate analysis revealed that diabetes mellitus (P = 0.031), multiple abscesses (P = 0.026), internal gas bubble (P = 0.041), metastatic infection (P = 0.004), and septic shock (P = 0.002) were significantly associated with mortality.

Conclusion

Thin-walled abscess, metastatic infection, absence of rim enhancement, and absence of underlying biliary tract disease are potentially useful CT findings for early KP-PLA diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wang JH, Liu YC, Lee SSJ, Yen MY, Chen YS, Wang JH, Wann SR, Lin HH (1998) Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis 26 (6):1434-1438. doi:Doi 10.1086/516369

    Article  CAS  PubMed  Google Scholar 

  2. Chung DR, Lee SS, Lee HR, Kim HB, Choi HJ, Eom JS, Kim JS, Choi YH, Lee JS, Chung MH, Kim YS, Lee H, Lee MS, Park CK, Abscess KSGL (2007) Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infection 54 (6):578-583. doi:10.1016/j.jinf.2006.11.008

    Article  CAS  Google Scholar 

  3. Wang J, Yan Y, Xue XY, Wang KF, Shen DX (2013) Comparison of pyogenic liver abscesses caused by hypermucoviscous Klebsiella pneumoniae and non-Klebsiella pneumoniae pathogens in Beijing: A retrospective analysis. J Int Med Res 41 (4):1088-1097. doi:10.1177/0300060513487645

    Article  CAS  PubMed  Google Scholar 

  4. Braiteh F, Golden MP (2007) Cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome. Int J Infect Dis 11 (1):16-22. doi:10.1016/j.ijid.2005.10.006

    Article  PubMed  Google Scholar 

  5. Lederman ER, Crum NE (2005) Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: An emerging disease with unique clinical characteristics. Am J Gastroenterol 100 (2):322-331. doi:DOI 10.1111/j.1572-0241.2005.40310.x

    Article  PubMed  Google Scholar 

  6. Yang CC, Yen CH, Ho MW, Wang JH (2004) Comparison of pyogenic liver abscess caused by non-Klebsiella pneumoniae and Klebsiella pneumoniae. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 37 (3):176-184

  7. Chen SC, Wu WY, Yeh CH, Lai KC, Cheng KS, Jeng LB, Wang PH, Lin DB, Chen CC, Lee MC, Bell WR (2007) Comparison of Escherichia coli and Klebsiella pneumoniae liver abscesses. The American journal of the medical sciences 334 (2):97-105. doi:10.1097/MAJ.0b013e31812f59c7

    Article  PubMed  Google Scholar 

  8. Rahimian J, Wilson T, Oram V, Holzman RS (2004) Pyogenic liver abscess: Recent trends in etiology and mortality. Clin Infect Dis 39 (11):1654-1659. doi:Doi 10.1086/425616

    Article  PubMed  Google Scholar 

  9. Mortele KJ, Segatto E, Ros PR (2004) The infected liver: Radiologic-pathologic correlation. Radiographics 24 (4):937-955. doi:Doi 10.1148/Rg.244035719

    Article  PubMed  Google Scholar 

  10. Alsaif HS, Venkatesh SK, Chan DSG, Archuleta S (2011) CT Appearance of Pyogenic Liver Abscesses Caused by Klebsiella pneumoniae. Radiology 260 (1):129-138. doi:10.1148/radiol.11101876

    Article  PubMed  Google Scholar 

  11. Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY (2012) Klebsiella pneumoniae liver abscess: a new invasive syndrome. The Lancet Infectious diseases 12 (11):881-887. doi:10.1016/S1473-3099(12)70205-0

    Article  PubMed  Google Scholar 

  12. Qian Y, Wong CC, Lai S, Chen H, He X, Sun L, Wu J, Zhou J, Yu J, Liu W, Zhou D, Si J (2016) A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015. Scientific reports 6:38587. doi:10.1038/srep38587

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kim SB, Je BK, Lee KY, Lee SH, Chung HH, Cha SH (2007) Computed tomographic differences of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-Klebsiella pneumoniae. Journal of computer assisted tomography 31 (1):59-65. doi:10.1097/01.rct.0000224629.48068.69

    Article  PubMed  Google Scholar 

  14. Hui JY, Yang MK, Cho DH, Li A, Loke TK, Chan JC, Woo PC (2007) Pyogenic liver abscesses caused by Klebsiella pneumoniae: US appearance and aspiration findings. Radiology 242 (3):769-776. doi:10.1148/radiol.2423051344

    Article  PubMed  Google Scholar 

  15. Mathieu D, Vasile N, Fagniez PL, Segui S, Grably D, Larde D (1985) Dynamic CT features of hepatic abscesses. Radiology 154 (3):749-752. doi:10.1148/radiology.154.3.3969480

    Article  CAS  PubMed  Google Scholar 

  16. Lee NK, Kim S, Lee JW, Jeong YJ, Lee SH, Heo J, Kang DH (2011) CT differentiation of pyogenic liver abscesses caused by Klebsiella pneumoniae vs non-Klebsiella pneumoniae. The British journal of radiology 84 (1002):518-525. doi:10.1259/bjr/23004588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lau YJ, Hu BS, Wu WL, Lin YH, Chang HY, Shi ZY (2000) Identification of a major cluster of Klebsiella pneumoniae isolates from patients with liver abscess in Taiwan. Journal of clinical microbiology 38 (1):412-414

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Lee KH, Han JK, Jeong JY, Kim YJ, Lee HJ, Park SH, Choi BI (2005) Hepatic attenuation differences associated with obstruction of the portal or hepatic veins in patients with hepatic abscess. AJR American journal of roentgenology 185 (4):1015-1023. doi:10.2214/AJR.04.1254

    Article  PubMed  Google Scholar 

  19. Syed MA, Kim TK, Jang HJ (2007) Portal and hepatic vein thrombosis in liver abscess: CT findings. European journal of radiology 61 (3):513-519. doi:10.1016/j.ejrad.2006.11.022

    Article  PubMed  Google Scholar 

  20. Chang FY, Chou MY (1995) Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens. Journal of the Formosan Medical Association = Taiwan yi zhi 94 (5):232-237

  21. Chen SY, Lin CH, Chang HM, Yu JC, Yu CY, Chang FY, Hsieh CB (2007) Education and imaging. Hepatobiliary and pancreatic: gas-forming pyogenic liver abscess. Journal of gastroenterology and hepatology 22 (1):133. https://doi.org/10.1111/j.1440-1746.2006.04813.x

  22. Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS (1991) Septic Metastatic Lesions of Pyogenic Liver-Abscess - Their Association with Klebsiella-Pneumoniae Bacteremia in Diabetic-Patients. Arch Intern Med 151 (8):1557-1559

    Article  CAS  Google Scholar 

  23. Kuramochi G, Takei S, Sato M, Isokawa O, Takemae T, Takahashi A (2005) Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess. Hepatol Res 31 (1):48-52. doi:10.1016/j.hepres.2004.09.006

    Article  PubMed  Google Scholar 

  24. Yang PW, Lin HD, Wang LM (2008) Pyogenic liver abscess associated with septic pulmonary embolism. J Chin Med Assoc 71 (9):442-447. doi:Doi 10.1016/S1726-4901(08)70146-1

    Article  PubMed  Google Scholar 

  25. Maffiolo C, Novellas S, Chevallier P, Brunner P, Mourou MY, Bruneton JN (2006) Thrombophlebitis of the hepatic veins: complication of a Klebsiella liver abscess. Clinical imaging 30 (1):63-65. doi:10.1016/j.clinimag.2005.07.021

    Article  PubMed  Google Scholar 

  26. Chou FF, Sheen-Chen SM, Chen YS, Chen MC, Chen FC, Tai DI (1994) Prognostic factors for pyogenic abscess of the liver. Journal of the American College of Surgeons 179 (6):727-732

    CAS  PubMed  Google Scholar 

  27. Hsieh CB, Tzao C, Yu CY, Chen CJ, Chang WK, Chu CH, Chou SJ, Tung HJ, Yu JC (2006) APACHE II score and primary liver cancer history had risk of hospital mortality in patients with pyogenic liver abscess. Digest Liver Dis 38 (7):498-502. doi:10.1016/j.dld.2006.03.020

    Article  Google Scholar 

  28. Yang CC, Chen CY, Lin XZ, Chang TT, Shin JS, Lin CY (1993) Pyogenic Liver-Abscess in Taiwan - Emphasis on Gas-Forming Liver-Abscess in Diabetics. Am J Gastroenterol 88 (11):1911-1915

    CAS  PubMed  Google Scholar 

  29. Chou FF, Sheenchen SM, Chen YS, Lee TY (1995) The Comparison of Clinical Course and Results of Treatment between Gas-Forming and Non-Gas-Forming Pyogenic Liver-Abscess. Arch Surg-Chicago 130 (4):401-405

    Article  CAS  Google Scholar 

  30. Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, Zuidema GD (1996) Pyogenic hepatic abscess - Changing trends over 42 years. Ann Surg 223 (5):600-607. doi:Doi 10.1097/00000658-199605000-00016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Johannsen EC, Sifri CD, Madoff LC (2000) Pyogenic liver abscesses. Infectious disease clinics of North America 14 (3):547-563, vii

  32. Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC (2007) Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 45 (3):284-293. doi:10.1086/519262

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors received no financial support for this study.

Author information

Authors and Affiliations

  1. Department of Radiology, Gil Medical Center of Gachon University, Namdong-gu, Incheon, Republic of Korea

    Jin Hwan Lee, Su Joa Ahn, Seung Joon Choi & Hyung Sik Kim

  2. Department of Infectious Disease of Internal Medicine, Gil Medical Center of Gachon University, 24 Namdong-daero, 774-beon-gil, Namdong-gu, Incheon, Republic of Korea

    Young Rock Jang

Authors
  1. Jin Hwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Rock Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Su Joa Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seung Joon Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyung Sik Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to and approved the final version of this manuscript. JHL analyzed and interpreted the data, drafted the manuscript, performed statistical analysis. YRJ orchestrated the study concept and design, acquired data, performed critical revision of the manuscript, and supervised the overall study. SJA, SJC, and HSK acquired clinical data and assisted in the critical revision of the final manuscript.

Corresponding author

Correspondence to Young Rock Jang.

Ethics declarations

Conflict of interest

We have no conflicts of interest to disclose.

Informed consent

Acquisition of informed consent was waived for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.H., Jang, Y.R., Ahn, S.J. et al. A retrospective study of pyogenic liver abscess caused primarily by Klebsiella pneumoniae vs. non-Klebsiella pneumoniae: CT and clinical differentiation. Abdom Radiol 45, 2669–2679 (2020). https://doi.org/10.1007/s00261-019-02389-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-02389-2

Keywords

Search

Navigation