Liver abscess due to Klebsiella pneumoniae: risk factors for metastatic infection.
BACKGROUND
Klebsiella pneumoniae-associated liver abscess (KPLA) is often accompanied by extrahepatic complications. We investigated the clinical features and outcomes of patients with and without metastatic infections and compared the 2 groups.


METHODS
We retrospectively reviewed the medical records of 161 patients with KPLA who were admitted to 2 tertiary referral hospitals in Korea.


RESULTS
In total, 9.9% had a metastatic infection. The most commonly involved distant sites were the eyes (n = 7) and the lungs (n = 6). In multivariate analysis, diabetes mellitus as an underlying disease (odds ratio (OR) 2.30, 95% confidence interval (CI) 1.05-9.51; p = 0.03) and a platelet count < 80,000/mm(3) (OR 11.60, 95% CI 2.53-53.26; p = 0.002) were associated with metastatic infection. Extended-spectrum beta-lactamase (ESBL) production was not observed in K. pneumoniae from patients with metastatic infection, whereas 3.4% of the bacteria in patients without metastatic infection had ESBL production. However, this difference was not statistically significant (p = 0.45). The in-hospital mortality rate was not significantly different (0% vs. 2.8%; p = 0.52). By multivariate analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score was independently associated with mortality among patients with KPLA (OR 1.5, 95% CI 1.12-2.00; p = 0.006).


CONCLUSIONS
Clinicians must be aware of potential metastatic infections in patients with KPLA, especially if they have diabetes mellitus and thrombocytopenia. The APACHE II score was predictive of mortality in patients with KPLA.
From the Department of Internal Medicine, The Hallym University College of Medicine , Chuncheon.
Jai Hoon
JH
Yoon
Youn Jeong
YJ
Kim
Yoon Hee
YH
Jun
Sang Il
SI
Kim
Ji Young
JY
Kang
Ki Tae
KT
Suk
Dong Joon
DJ
Kim
D000328:Adult; D000368:Aged; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000473:pathology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008100:Liver Abscess / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013921:Thrombocytopenia / Q000150:complications