title: Standardized outpatient management of Klebsiella pneumoniae liver abscesses.
abstract: OBJECTIVE
  Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment.
  
  
  METHODS
  We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality.
  
  
  RESULTS
  All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02).
  
  
  CONCLUSIONS
  The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.
authors.affiliation: Department of Laboratory Medicine, National University Hospital System, 5 Lower Kent Ridge Road, 119074, Singapore. douglas_sg_chan@nuhs.edu.sg
authors.forename: Douglas S G
authors.initials: DS
authors.lastname: Chan
authors.forename: Sophia
authors.initials: S
authors.lastname: Archuleta
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Llorin
authors.forename: David C
authors.initials: DC
authors.lastname: Lye
authors.forename: Dale
authors.initials: D
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008100:Liver Abscess / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents