BacteriologyMicrobiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures
Introduction
Although rare, pyogenic liver abscesses are potentially fatal if surgical drainage and appropriate antimicrobial therapy are not instituted early in the course of the disease Bertel et al 1986, Huang et al 1996, Seeto and Rockey 1996. Because early diagnosis and treatment are essential for patient survival, we evaluated the predictive value, sensitivity, and specificity of Gram stain of liver abscess aspirates, and of temporally associated blood cultures. Our goal was to ascertain the usefulness of these microbiologic tests in establishing the causative organism(s) of a liver abscess, which has therapeutic implications.
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Patient selection
Thirty-eight patients with 40 episodes of liver abscess identified at our institution from October 1995 to November 2000 were selected from the computerized microbiology database. Patients included in the study met all of the following criteria: 1) they had a clinical diagnosis of liver abscess, 2) a diagnostic radiologic study was available, and 3) a bacterial culture from the liver abscess was positive. We reviewed demographics, associated diseases, Gram stain results from the liver
Results
The mean age of the 38 patients with liver abscess was 56 years [range: 15-82], and 23 (61%) were male. Of these 38 patients, 18 (47%) had had recent abdominal surgery (including liver transplantation, Whipple’s procedure, cholecystectomy, Billroth II, and small bowel resection), 18 (47%) had biliary tract and/or liver disease, 12 (32%) had an intra-abdominal neoplasm (including cholangiocarcinoma, pancreatic cancer, colon and gastric adenocarcinoma, and intraabdominal desmoid tumor), and 2
Discussion
Almost half of the patients in this review had had recent abdominal surgery and had biliary tract and/or liver disease before developing a liver abscess. Only 2 of the 38 patients had no predisposing factors contributing to liver abscesses (i.e., cryptogenic abscesses). Oschner et al., in their classic paper from 1938, noted that liver abscesses mainly affected young male patients with intra-abdominal infections, usually pylephlebitis secondary to acute appendicitis (Oschner et al., 1938).
References (15)
- et al.
Pyogenic liver abscesses
Infect Dis Clin North Am
(2000) - et al.
Is the stat Gram stain helpful during percutaneous image-guided fluid drainage?
Acad Radiol
(2000) - et al.
Pyogenic abscess of the liver. II. An analysis of forty-seven cases with review of the literature
Am J Surg
(1938) - et al.
The role of intraoperative Gram stain in the diagnosis of infection during revision total hip arthroplasty
J Arthroplasty
(1999) - et al.
Treatment of pyogenic liver abscesses. Surgical vs percutaneous drainage
Arch Surg
(1986) - et al.
The diagnostic value of Gram stain for initial identification of the etiologic agent of peritonitis in CAPD patients
Perit Dial Int
(1997) - et al.
Hepatic abscess
Changes in etiology, diagnosis and management. Ann Surg
(1990)
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