Pyogenic liver abscess
- Joshua Davis, PhD, MBBS, FRACP
Joshua Davis, PhD, MBBS, FRACP
- Infectious Diseases Physician and Associate Professor
- Menzies School of Health Research
- Malcolm McDonald, PhD, FRACP, FRCPA
Malcolm McDonald, PhD, FRACP, FRCPA
- Associate Professor
- School of Medicine and Dentistry, James Cook University
Pyogenic liver abscesses usually develop following peritonitis due to leakage of intraabdominal bowel contents that subsequently spread to liver via the portal circulation or via direct spread from biliary infection. They may also result from arterial hematogenous seeding in the setting of systemic infection.
The clinical approach to pyogenic liver abscess will be reviewed here. Amebic abscesses are discussed separately. (See "Extraintestinal Entamoeba histolytica amebiasis".)
Prevalence — Liver abscesses are the most common type of visceral abscess; in a report of 540 cases of intraabdominal abscesses, pyogenic liver abscesses accounted for 48 percent of visceral abscesses and 13 percent of intraabdominal abscesses . The annual incidence of liver abscess has been estimated at 2.3 cases per 100,000 populations and is higher among men than women (3.3 versus 1.3 per 100,000) [2-4]; substantially higher rates have been reported in Taiwan (17.6 cases per 100,000) .
Risk factors — Risk factors include diabetes, underlying hepatobiliary or pancreatic disease, and liver transplant [2,3,6,7]. Geographic and host factors may also play a role; for example, a primary invasive liver abscess syndrome due to K. pneumoniae has been described in East Asia. This is discussed separately. (See "Invasive liver abscess syndrome caused by Klebsiella pneumoniae".)
Association with colorectal neoplasia — Several studies from Asia, where K. pneumoniae is the primary cause of pyogenic liver abscesses, have suggested an association with underlying colorectal cancer [8-13]. It is unclear whether these findings can be applied to other parts of the world.
- Altemeier WA, Culbertson WR, Fullen WD, Shook CD. Intra-abdominal abscesses. Am J Surg 1973; 125:70.
- Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg 1996; 223:600.
- Mohsen AH, Green ST, Read RC, McKendrick MW. Liver abscess in adults: ten years experience in a UK centre. QJM 2002; 95:797.
- Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol 2004; 2:1032.
- Tsai FC, Huang YT, Chang LY, Wang JT. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis 2008; 14:1592.
- Chan KS, Chen CM, Cheng KC, et al. Pyogenic liver abscess: a retrospective analysis of 107 patients during a 3-year period. Jpn J Infect Dis 2005; 58:366.
- Thomsen RW, Jepsen P, Sørensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis. Clin Infect Dis 2007; 44:1194.
- Kao WY, Hwang CY, Chang YT, et al. Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study. Aliment Pharmacol Ther 2012; 36:467.
- Koo HC, Kim YS, Kim SG, et al. Should colonoscopy be performed in patients with cryptogenic liver abscess? Clin Res Hepatol Gastroenterol 2013; 37:86.
- Jeong SW, Jang JY, Lee TH, et al. Cryptogenic pyogenic liver abscess as the herald of colon cancer. J Gastroenterol Hepatol 2012; 27:248.
- Qu K, Liu C, Wang ZX, et al. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia. World J Gastroenterol 2012; 18:2948.
- Huang WK, Chang JW, See LC, et al. Higher rate of colorectal cancer among patients with pyogenic liver abscess with Klebsiella pneumoniae than those without: an 11-year follow-up study. Colorectal Dis 2012; 14:e794.
- Lai HC, Lin CC, Cheng KS, et al. Increased incidence of gastrointestinal cancers among patients with pyogenic liver abscess: a population-based cohort study. Gastroenterology 2014; 146:129.
- Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis 2004; 39:1654.
- Chen SC, Huang CC, Tsai SJ, et al. Severity of disease as main predictor for mortality in patients with pyogenic liver abscess. Am J Surg 2009; 198:164.
- Lok KH, Li KF, Li KK, Szeto ML. Pyogenic liver abscess: clinical profile, microbiological characteristics, and management in a Hong Kong hospital. J Microbiol Immunol Infect 2008; 41:483.
- Lam YH, Wong SK, Lee DW, et al. ERCP and pyogenic liver abscess. Gastrointest Endosc 1999; 50:340.
- Zaleznik, DF, Kasper, DL. Intra-abdominal abscesses. In: Gastrointestinal Infections: Diagnosis and Management, Lamont, JT (Ed), Marcel Dekker, New York 1997. p.397.
- Kasper, DL, Zaleznik, DF. Intra-abdominal infections and abscesses. In: Harrison's Principles of Internal Medicine. 16th ed. Kasper, DL, Braunwald, E, Fauci, AS, Hauser, SL, Longo, DL, Jameson, JL (Eds), McGraw-Hill, New York 2005. p.749.
- Chen C, Chen PJ, Yang PM, et al. Clinical and microbiological features of liver abscess after transarterial embolization for hepatocellular carcinoma. Am J Gastroenterol 1997; 92:2257.
- Lodhi S, Sarwari AR, Muzammil M, et al. Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. Trop Med Int Health 2004; 9:718.
- Everts RJ, Heneghan JP, Adholla PO, Reller LB. Validity of cultures of fluid collected through drainage catheters versus those obtained by direct aspiration. J Clin Microbiol 2001; 39:66.
- Rubin RH, Swartz MN, Malt R. Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Am J Med 1974; 57:601.
- McDonald MI, Corey GR, Gallis HA, Durack DT. Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage. Medicine (Baltimore) 1984; 63:291.
- Chemaly RF, Hall GS, Keys TF, Procop GW. Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures. Diagn Microbiol Infect Dis 2003; 46:245.
- Rajak CL, Gupta S, Jain S, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol 1998; 170:1035.
- Ch Yu S, Hg Lo R, Kan PS, Metreweli C. Pyogenic liver abscess: treatment with needle aspiration. Clin Radiol 1997; 52:912.
- Yu SC, Ho SS, Lau WY, et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatology 2004; 39:932.
- Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol 2007; 189:W138.
- Tan YM, Chung AY, Chow PK, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm. Ann Surg 2005; 241:485.
- Bertel, CK, van Heerden, JA, Sheedy, PF. Treatment of pyogenic hepatic abscesses: Surgical vs percutaneous drainage. Arch Surg 1986; 121:554.
- Liu CH, Gervais DA, Hahn PF, et al. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol 2009; 20:1059.
- Sersté T, Bourgeois N, Vanden Eynden F, et al. Endoscopic drainage of pyogenic liver abscesses with suspected biliary origin. Am J Gastroenterol 2007; 102:1209.
- K C S, Sharma D. Long-term follow-up of pyogenic liver abscess by ultrasound. Eur J Radiol 2009; [Epub ahead of print].
- Chen YW, Chen YS, Lee SS, et al. A pilot study of oral fleroxacin once daily compared with conventional therapy in patients with pyogenic liver abscess. J Microbiol Immunol Infect 2002; 35:179.