title: Pyogenic liver abscess caused by Pseudomonas aeruginosa: clinical analysis of 20 cases.
abstract: BACKGROUND
  There are few reports of Pseudomonas aeruginosa liver abscess (PALA) in the literature, and clinical information regarding its risk factors, route of transmission, and clinical course remains limited.
  
  
  METHODS
  The medical records of 1076 patients with pyogenic liver abscess treated at Chang Gung Memorial Hospital were reviewed.
  
  
  RESULTS
  Twenty of the patients whose records were analyzed had PALA. Mortality was 20%. Five patients with PALA, diagnosed immediately following an intra-abdominal surgical or endoscopic procedure, were classified as group A. The latent phase for the development of PALA in this group was less than 3 weeks. The remaining 15 patients were further subgrouped into group B (n = 8), with a traceable intra-abdominal procedure, and group C (n = 7), with no history of an invasive intra-abdominal procedure. The latent period in patients in group B varied from 6 weeks to 3.7 y. The absence of multidrug resistance in P. aeruginosa isolates from group C suggests the community-acquired nature of the infection in this group. Risk factor analysis showed that the incidence of hepatobiliary co-morbidities was high in all the groups (100%, 88%, and 71% in groups A, B, and C, respectively). The rates of co-infection with human gastrointestinal tract flora were 20%, 50%, and 71% in groups A, B, and C, respectively.
  
  
  CONCLUSIONS
  PALA may be found in subjects without conventional risk factors for P. aeruginosa infection. In addition to patients with a preceding contaminated procedure, those with hepatobiliary co-morbidities form another high-risk group for this condition.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
authors.forename: Wei-Hsin
authors.initials: WH
authors.lastname: Chen
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Chung-Huei
authors.initials: CH
authors.lastname: Huang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Jui-Hung
authors.initials: JH
authors.lastname: Sun
authors.forename: Yu-Yao
authors.initials: YY
authors.lastname: Huang
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications; D005260:Female; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification* / Q000472:pathogenicity; D012307:Risk Factors