title: Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes.
abstract: In times of modern surgery, transplantation and percutaneous techniques, pyogenic liver abscess (PLA) has essentially become a problem of biliary or iatrogenic origin. In the current scenario, diagnostic approach, clinical behavior and therapeutic outcomes have not been profoundly studied. This study analyzes the clinical and microbiological features, diagnostic methods, therapeutic management and predictive factors for recurrence and mortality of first episodes of PLA.
  
  
  
  A retrospective single-center study was conducted including 142 patients admitted to the Hospital Italiano de Buenos Aires, between 2005 and 2015 with first episodes of PLA.
  
  
  
  Prevailing identifiable causes were biliary diseases (47.9%) followed by non-biliary percutaneous procedures (NBIPLA, 15.5%). Seventeen patients (12%) were liver recipients. Eleven patients (7.8%) died and 18 patients (13.7%) had recurrence in the first year of follow up. The isolation of multiresistant organisms (p = 0.041) and a history of cholangitis (p < 0.001) were independent risk factors for recurrence. Mortality was associated with serum bilirubin >5 mg/dL (p = 0.022) and bilateral involvement (p = 0.014) in the multivariate analysis.
  
  
  
  NBPLA and PLA after transplantation may be increasing among the population of PLA in referral centers. History of cholangitis is a strong predictor for recurrence. Mortality is associated to hiperbilirrubinemia and anatomical distribution of the lesions.
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Matías E
authors.initials: ME
authors.lastname: Czerwonko
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Huespe
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Bertone
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Pellegrini
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Mazza
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina. Electronic address: martin.desantibanes@hospitalitaliano.org.ar.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Hyon
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
authors.forename: Martín
authors.initials: M
authors.lastname: de Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D049448:Cholangiopancreatography, Magnetic Resonance; D002761:Cholangitis / Q000150:complications; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin