title: Patients with culture negative pyogenic liver abscess have the same outcomes compared to those with Klebsiella pneumoniae pyogenic liver abscess.
abstract: BACKGROUND
  Etiologic organism is not frequently isolated despite multiple blood and fluid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogenic liver abscess (CNPLA) is routinely managed by antibiotics targeted to Klebsiella pneumoniae. In this study, we evaluated the outcomes of such clinical practice.
  
  
  METHODS
  All the patients with CNPLA and Klebsiella pneumoniae PLA (KPPLA) admitted from January 2003 to December 2011 were included in the study. A retrospective review of medical records was performed and demographic, clinical and outcome data were collected.
  
  
  RESULTS
  A total of 528 patients were treated as CNPLA or KPPLA over the study period. CNPLA presented more commonly with abdominal pain (P=0.024). KPPLA was more common in older age (P=0.029) and was associated with thrombocytopenia (P=0.001), elevated creatinine (P=0.002), bilirubin (P=0.001), alanine aminotransferase (P=0.006) and C-reactive protein level (P=0.036). CNPLA patients tend to have anemia (P=0.015) and smaller abscess (P=0.008). There was no difference in hospital stay (15.7 vs 16.8 days) or mortality (14.0% vs 11.0%). No patients required surgical drainage after initiation of medical therapy.
  
  
  CONCLUSIONS
  Despite demographic and clinical differences between CNPLA and KPPLA, overall outcomes are not different.
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: Qiao
authors.initials: Q
authors.lastname: Wang
authors.forename: Clement Lk
authors.initials: CL
authors.lastname: Chia
authors.forename: Zhongkai
authors.initials: Z
authors.lastname: Wang
authors.forename: Jee Keem
authors.initials: JK
authors.lastname: Low
authors.forename: Winston Wl
authors.initials: WW
authors.lastname: Woon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000472:pathogenicity; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents