Extended-spectrum cephalosporin compared to cefazolin for treatment of Klebsiella pneumoniae-caused liver abscess.
From January 1995 to May 2000, a total of 107 adults with liver abscess due to Klebsiella pneumoniae admitted at a large medical center in northern Taiwan were reviewed. Patients were considered to have received cefazolin or an extended-spectrum cephalosporin if they received at least 3 days of that antibiotic within the first 5 days of hospitalization. Fifty-nine (55.1%) patients received cefazolin, and 48 (44.9%) patients received an extended-spectrum cephalosporin. The demographic data, clinical features, severities of illness, and rates of early drainage for the two groups were comparable. However, the rates of developing complications for the two groups were significantly different (37.3 versus 6.3%, respectively; P < 0.001). Furthermore, six independent factors preventing severe complications following liver abscess due to K. pneumoniae were identified: normal platelet count, alkaline phosphatase less than 300 U/liter, no gas formation in the abscess, APACHE III score less than 40, use of an extended-spectrum cephalosporin, and early drainage. In conclusion, cefazolin therapy may be suboptimal for patients with liver abscess due to K. pneumoniae despite active in vitro susceptibility. Use of an extended-spectrum cephalosporin and early drainage for patients with liver abscess due to K. pneumoniae are suggested.
Cheng
Hsiao-Pei
HP
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, National Health Research Institute, Taipei, Taiwan.
Siu
L K
LK
Chang
Feng-Yee
FY
D018806:APACHE; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002437:Cefazolin / Q000008:administration & dosage*; D002511:Cephalosporins / Q000008:administration & dosage*; D004322:Drainage; D005260:Female; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008100:Liver Abscess / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002437:Cefazolin