title: Unique characteristics of pyogenic liver abscesses of biliary origin.
abstract: BACKGROUND
  Pyrogenic liver abscesses (PLA) can be caused by cholangitis associated with hepatolithiasis and cholangitis related to an abnormal bilioenteric communication, such as a hepaticojejunostomy or the presence of indwelling biliary stents. Our aim was to evaluate the clinical characteristics of PLA of biliary origin.
  
  
  METHODS
  We compared patients with PLA related to biliary tract disease (PLA-B; n = 125) with patients with PLA not related to biliary tract disease (PLA-NB; n = 444). We also separated the patients with PLA-B into PLA related to biliary tract disease that involved an abnormal bilioenteric communication, including hepaticojejunostomy and indwelling biliary stents (PLA-B-AC; n = 38), and PLA-B not related to abnormal communication (n = 87), and compared them.
  
  
  RESULTS
  Among the 569 patients with PLA from 2008 to 2013, the most common etiologies were cryptogenic (n = 341; 60%) and biliary (n = 125; 22%). Patients with PLA-B tended to have a higher maximum body temperature and a greater leukocytosis. The incidences of bacteremia, septic shock, death, and postdischarge recurrence were greater in the PLA-B group when compared with the PLA-NB group. The most commonly isolated pathogenic bacteria in PLA-B group were Escherichia coli (36%) and Klebsiella pneumonia (23%). In contrast, in the PLA-NB group, the most common pathogen was K pneumonia (64%), whereas E coli was uncommon (only 5%). Independent risk factors for the occurrence of PLA-B were isolates with multidrug resistant (MDR) bacteria, bacteremia, E coli, and polymicrobial infection. In the group of PLA-B-AC, risk factors included MDR bacteria and a history of malignancy.
  
  
  CONCLUSIONS
  The occurrences of PLA-B are often infected with MDR bacteria and mixed infections caused mainly by E coli and other isolates and associated with bacteremia; PLA-B-AC are associated with MDR bacteria and a history of malignancy.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Shaohua
authors.initials: S
authors.lastname: Shi
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Weiliang
authors.initials: W
authors.lastname: Xia
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China.
authors.forename: Haijun
authors.initials: H
authors.lastname: Guo
authors.affiliation: Clinical Lab of Microbiology, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Haishen
authors.initials: H
authors.lastname: Kong
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, Zhejiang Province, China; Key Laboratory of Organ Transplantation, Hangzhou, Zhejiang Province, China. Electronic address: sms3391@hotmail.com.
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002761:Cholangitis / Q000150:complications*; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000209:etiology*; D007711:Klebsiella pneumoniae; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index