title: Liver Abscess Formation Following Transarterial Chemoembolization: Clinical Features, Risk Factors, Bacteria Spectrum, and Percutaneous Catheter Drainage.
abstract: To investigate the clinical features, risk factors, and bacterial spectrum of liver abscess following transarterial chemoembolization (TACE) and evaluate the therapeutic effect of percutaneous catheter drainage (PCD) on the abscesses.A retrospective review of patient charts was performed in 3613 patients who suffered from liver malignancies (2832 patients with hepatocellular carcinoma and 781 with metastatic hepatic tumor) and had undergone 11,054 TACE procedures from January 2005 to October 2013. Liver abscesses were found in 21 patients. PCD was performed in all abscess patients. The clinical features, risk factors, and bacterial spectrum of liver abscess following TACE were investigated and the therapeutic effect of PCD was evaluated.The incidence of liver abscess was 0.58% per patient and 0.19% per procedure. Approximately 57.1% of the patients had a medical history of bilioenteric anastomosis or biliary stent implantation. On computed tomography scans, the abscesses appeared as low-attenuation lesions and high-density iodinate oil scattered in the abscesses. The ultrasound showed the well defined, heterogeneously hypoechoic lesions. Positive microbiological isolates were obtained in all pus cultures and in 47.6% of blood cultures. The most common bacterium was Escherichia coli (52.4%). Twenty patients (95.2%) were cured from abscesses by using PCD, and 1 died of sepsis.Patients with predisposing factors are prone to an increased risk of liver abscess following TACE. Bacterial culture and antibiotic sensitivity tests on pus and blood help on the antibiotics selection. PCD combined with aggressive antibiotics can be recommended as the first-line therapeutic regimen.
authors.affiliation: From the Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Wei-Fu
authors.initials: WF
authors.lastname: Lv
authors.forename: Dong
authors.initials: D
authors.lastname: Lu
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: He
authors.forename: Jing-Kun
authors.initials: JK
authors.lastname: Xiao
authors.forename: Chun-Ze
authors.initials: CZ
authors.lastname: Zhou
authors.forename: De-Lei
authors.initials: DL
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000628:therapy; D001424:Bacterial Infections / Q000382:microbiology* / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D004927:Escherichia coli Infections / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000382:microbiology* / Q000628:therapy*; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome