title: Pyogenic Liver Abscess: Does Escherichia Coli Cause more Adverse Outcomes than Klebsiella Pneumoniae?
abstract: BACKGROUND
  This paper aims to demonstrate if Escherichia coli pyogenic liver abscess (ECPLA) results in adverse outcomes compared to Klebsiella pneumoniae PLA (KPPLA).
  
  
  METHODS
  A retrospective review of all patients admitted at a tertiary hospital in Singapore from 2003 to 2011 was performed. Patients with age <18 years, amoebic liver abscess, infected liver cyst, culture negative abscess or ruptured liver abscess requiring urgent surgical intervention were excluded. Only patients with blood or pus culture confirmation of ECPLA (n = 24) or KPPLA (n = 264) were included. Median length of hospital stay, failure of non-operative therapy and 30-day mortality are the reported outcomes.
  
  
  RESULTS
  ECPLA affects older patients (68 vs. 62 years, p = 0.049). Ischemic heart disease was more common in ECPLA (29 vs. 14 %, p = 0.048) and there was no difference in diabetic state (42 vs. 38 %, p = 0.743). ECPLA is more commonly associated with hyperbilirubinemia (60 vs. 34 µmol/L, p = 0.003), increased gamma-glutamyl transpeptidase (236 vs. 16 IU/L, p = 0.038) and gallstones (58 vs. 30 %, p = 0.004). KPPLA are larger in size (6 vs. 4 cm, p = 0.006) and had percutaneous drainage (PD) more frequently (64 vs. 42 %, p = 0.034). There was no difference in median hospital stay (14 vs. 14 days, p = 0.110) or 30-day mortality (17 vs. 10 %, p = 0.307) between ECPLA and KPPLA. Among patients with ECPLA, antibiotic treatment with PD appeared to have higher mortality compared to antibiotic treatment alone (30 vs. 7 %) but this was not significant (p = 0.272).
  
  
  CONCLUSIONS
  In the setting of multimodal care, outcomes of ECPLA are comparable to KPPLA.
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore, vgshelat@gmail.com.
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Shelat
authors.forename: Clement L K
authors.initials: CL
authors.lastname: Chia
authors.forename: Charleen S W
authors.initials: CS
authors.lastname: Yeo
authors.forename: Wang
authors.initials: W
authors.lastname: Qiao
authors.forename: Winston
authors.initials: W
authors.lastname: Woon
authors.forename: Sameer P
authors.initials: SP
authors.lastname: Junnarkar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000150:complications*; D005260:Female; D042882:Gallstones / Q000150:complications; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications; D007710:Klebsiella Infections / Q000150:complications*; D007711:Klebsiella pneumoniae; D007902:Length of Stay; D046290:Liver Abscess, Pyogenic / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D012189:Retrospective Studies; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D005723:gamma-Glutamyltransferase