title: Predictors of therapy failure in a series of 741 adult pyogenic liver abscesses.
abstract: BACKGROUND
  Adult pyogenic liver abscess (PLA) is a major hepato-biliary infection. We aim to identify risk factors associated with therapy failure.
  
  
  METHODS
  Retrospective study of 741 PLA patients (2001-2011) and comparison with earlier data (1994-1997). Risk factors associated with therapy failure were identified with multivariate analysis.
  
  
  RESULTS
  Incidence of PLA is 86/100 000 admissions, with average size 5.75 cm. 68% of PLA were secondary to Klebsiella pneumoniae and there is increasing extended-spectrum beta-lactamase (ESBL) resistance. Compared with 1990s, there is an increasing annual incidence (from 18 to 67). Elderly age (≥55-years-old), presence of multiple abscesses, malignancy as etiology and patients who underwent endoscopic intervention are independent predictors for failure of antibiotics-only therapy while average intravenous antibiotics duration and average abscess size are not. ECOG performance status ≥2, pre-existing hypertension and hyperbilirubinaemia are independent predictors for failure of percutaneous therapy while the presence of multiple abscesses and average abscess size are not.
  
  
  CONCLUSIONS
  There is an increasing PLA incidence with increasing ESBL resistance. Percutaneous drainage should be considered early for elderly patients (≥55-years-old), with multiple abscesses, malignancy as etiology or who required endoscopic intervention. We should have a low threshold for surgical intervention for patients with ECOG performance status ≥2, co-morbidity of hypertension or hyperbilirubinaemia.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433. zhiwen@gmail.com.
authors.forename: Joseph Zhi Wen
authors.initials: JZ
authors.lastname: Lo
authors.forename: Jeffrey Jia Jun
authors.initials: JJ
authors.lastname: Leow
authors.forename: Perryn Ling Fei
authors.initials: PL
authors.lastname: Ng
authors.forename: Hui Qi
authors.initials: HQ
authors.lastname: Lee
authors.forename: Nor Alia
authors.initials: NA
authors.lastname: Mohd Noor
authors.forename: Jee Keem
authors.initials: JK
authors.lastname: Low
authors.forename: Sameer P
authors.initials: SP
authors.lastname: Junnarkar
authors.forename: Winston Wei Liang
authors.initials: WW
authors.lastname: Woon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D046290:Liver Abscess, Pyogenic / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Hepatic abscess; Liver abscess