title: Pyogenic liver abscess: an audit of 10 years' experience.
abstract: OBJECTIVE
  To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.
  
  
  METHODS
  A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre, were reviewed. Amoebic and hydatid abscesses were excluded. Demographic, clinical, radiological, and microbiological characteristics, as well as surgical/radiological interventions, were recorded.
  
  
  RESULTS
  Sixty-three patients (42 males, 21 females) aged 65 (± 14) years [mean ± (SD)] had prodromal symptoms for a median (interquartile range; IQR) of 7 (5-14) d. Only 59% of patients were febrile at presentation; however, the serum C-reactive protein was elevated in all 47 in whom it was measured. Liver function tests were non-specifically abnormal. 67% of patients had a solitary abscess, while 32% had > 3 abscesses with a median (IQR) diameter of 6.3 (4-9) cm. Causative organisms were: Streptococcus milleri 25%, Klebsiella pneumoniae 21%, and Escherichia coli 16%. A presumptive cryptogenic cause was most common (34%). Four patients died in this series: one from sepsis, two from advanced cancer, and one from acute myocardial infarction. The initial procedure was radiological aspiration ± drainage in 54 and surgery in two patients. 17% underwent surgical management during their hospitalization. Serum hypoalbuminaemia [mean (95% CI): 32 (29-35) g/L vs 28 (25-31) g/L, P = 0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.
  
  
  CONCLUSIONS
  PLA is a diagnostic challenge, because the presentation of this condition is non-specific. Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs; However, a small proportion of patients still require surgical drainage.
authors.affiliation: Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, St Leonards NSW 2065, Australia.
authors.forename: Tony C Y
authors.initials: TC
authors.lastname: Pang
authors.forename: Thomas
authors.initials: T
authors.lastname: Fung
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Samra
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hugh
authors.forename: Ross C
authors.initials: RC
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D015415:Biomarkers / Q000097:blood; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013396:Suction; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers