title: Sonographically guided percutaneous treatment of liver abscesses in critically Ill patients.
abstract: BACKGROUND
  The management of liver abscess (LA) has shifted toward intravenous broad-spectrum antibiotics and image-guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD).
  
  
  OBJECTIVE
  To evaluate the efficacy of percutaneous treatment for patients with LA.
  
  
  METHODS
  We performed a retrospective analysis of 264 patients with 354 LA treated by percutaneous management from 1989 to 2012. All patients received appropriate antibiotic therapy. Patients with LA <50 mm in diameter were initially treated by sonographic-guided PNA and those with LA ≥50 mm were initially treated by ultrasound ultrasound-guided PCD. Surgery was planned only when there was no clinical improvement after the initial nonsurgical treatment. Primary outcome was the conversion rate to surgery. Secondary outcomes were mortality, length of hospital stay, and the procedure-related complications.
  
  
  RESULTS
  PNA was performed initially in 116 patients (44%), with 70 of them later requiring PCD due to abscess recurrence. In 148 patients (56%), PCD was performed initially. PCD was performed twice or more in 63 patients. Percutaneous treatment was the definitive and successful treatment in 230 of 264 patients (87.1%). Twenty patients (7.7%) were converted to surgery. Twenty-one patients (7.9%) died. The median hospital stay was 12 (range, 9-18) days, with complications occurring in 23 patients (8.7%).
  
  
  CONCLUSIONS
  Percutaneous management with systemic antibiotics is effective and safe and allows resolution of most LA. However, a small proportion of patients with LA still requires surgical drainage.
authors.affiliation: Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, University Clinical Center Tuzla, Bistrik 7, Sarajevo, Bosnia and Herzegovina.
authors.forename: Enver
authors.initials: E
authors.lastname: Zerem
authors.forename: Safet
authors.initials: S
authors.lastname: Omerovic
authors.forename: Suad
authors.initials: S
authors.lastname: Kunosic
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000379:methods; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008100:Liver Abscess / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013396:Suction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents
keywords: infection; interventional sonography; liver abscess; percutaneous catheter drainage; percutaneous needle aspiration; surgery