Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2020; 12(10): 816-828
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.816
Increased incidence of and microbiologic changes in pyogenic liver abscesses in the Mexican population
Juanita Pérez-Escobar, Wagner Ramirez-Quesada, Daniel Alejandro Calle-Rodas, Luis Alberto Chi-Cervera, Nalu Navarro-Alvarez, Jorge Aquino-Matus, Juan Pablo Ramírez-Hinojosa, Carlos Moctezuma-Velázquez, Aldo Torre
Juanita Pérez-Escobar, Wagner Ramirez-Quesada, Daniel Alejandro Calle-Rodas, Luis Alberto Chi-Cervera, Nalu Navarro-Alvarez, Carlos Moctezuma-Velázquez, Aldo Torre, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
Jorge Aquino-Matus, Juan Pablo Ramírez-Hinojosa, Department of Internal Medicine, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico
Author contributions: Pérez-Escobar J and Ramirez-Quesada W contributed equally to this manuscript: Designed the study, performed the research, and wrote the paper; Calle-Rodas DA, Chi-Cervera LA, Aquino-Matus J, and Ramírez-Hinojosa JP collected information from medical charts; Navarro-Alvarez N, Moctezuma-Velázquez C and Torre A contributed to the analysis and supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
Informed consent statement: Patients were not required to give informed consent because the data were obtained from medical charts. This was a retrospective study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Aldo Torre, MD, PhD, Attending Doctor, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, No.15, Vasco de Quiroga, Belisario Domínguez Secc 16, Mexico City 14080, Mexico. detoal@yahoo.com
Received: May 25, 2020
Peer-review started: May 25, 2020
First decision: June 12, 2020
Revised: June 26, 2020
Accepted: August 16, 2020
Article in press: August 16, 2020
Published online: October 27, 2020
Abstract
BACKGROUND

Pyogenic liver abscess (PLA) is a rare disease with an estimated incidence that varies widely across the globe, being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada. Even though there are multiple microorganisms capable of producing an abscess in the liver, including Entamoeba histolytica, fungi, and viruses, most abscesses are derived from bacterial infections. The epidemiology of PLA in Mexico is currently unknown.

AIM

To describe the clinical, demographic and microbiologic characteristics of PLA in Mexico.

METHODS

This is a retrospective study carried out in two centers, and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess. We collected demographic, clinical, and microbiological information, treatment, complications, and outcomes. A logistic regression analysis was used to determine the association between different variables and mortality rates.

RESULTS

A total of 345 patients were included in this study. 233 (67.5%) had confirmed PLA, 133 (30%) patients had no positive culture and negative serology and 9 (2.5%) had mixed abscesses. The mean age was 50 years (ranging from 16-97 years) and 63% were female. 65% of the patients had positive cultures for Extended Spectrum Beta-Lactamases (ESBL)-Escherichia coli and Klebsiella pneumoniae. Cefotaxime was administered in 60% of cases. The most common sources of infection were ascending cholangitis and cholecystitis in 34 (10%) and 31 (9%), respectively. The median length of hospital stay was 14 d. 165 patients underwent percutaneous catheter drainage. The inpatient mortality rate was 63%. Immunocompromised state [OR 3.9, 95%CI: 1.42-10.46], ESBL- Escherichia coli [OR 6.7, 95%CI: 2.7-16.2] and Klebsiella pneumoniae [OR 4-8, 95%CI: 1.6-14.4] predicted inpatient mortality by multivariate analysis.

CONCLUSION

The prevalence of PLA is increasing in Mexico and has a very high mortality rate. ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.

Keywords: Liver abscess, Pyogenic, Mexican population, Epidemiology, Complications, Outcomes, Mortality

Core Tip: In this retrospective study we investigated the clinical, demographic, and microbiologic characteristics of pyogenic liver abscess (PLA) in Mexico. We found that the prevalence of PLA in Mexico is increasing and had a very high mortality rate (63%) in our study. Our data also indicated that the presence of ESBL-Escherichia coli and Klebsiella pneumoniae and an immunocompromised state were independent predictors of high-risk mortality with an adjusted OR of 6.7, 4.8 and 3.9, respectively.