Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess

Susan Shin Jung Lee, Yao Shen Chen, Hung Chin Tsai, Shue Ren Wann, Hsi Hsun Lin, Chun Kai Huang, Yung Ching Liu

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Background. Primary liver abscess caused by Klebsiella pneumoniae is an infection that is emerging worldwide and that is associated with severe morbidity and considerable mortality. Methods. A retrospective analysis of 110 episodes of primary liver abscess caused by K. pneumoniae that required hospitalization during 2001-2002 was conducted to identify predictors of metastatic infection, mortality, and the efficacy of first-generation cephalosporins and percutaneous drainage. The potential role of Klebsiella rmpA and magA genes was also evaluated. Results. The study included 59 men and 51 women, with a mean age of 61.8 years. Diabetes was noted in 67 patients (60.9%). Metastatic infection occurred in 17 patients (15.5%), with meningitis accounting for 11 patients (64.7%) and endophthalmitis accounting for 4 patients (23.5%). The overall mortality rate was 10.0% (11 patients). Most of the severe complications occurred within the first 3 days after hospital admission. Ninety-two patients (83.6%) received treatment with cefazolin for >3 days. Four patients (4.3%) of the group who received cefazolin had metastatic infection, 1 patient (1.1%) experienced septic shock, and 3 (3.3%) experienced acute respiratory failure. Five (5.4%) of those 92 patients died. Multivariable analysis revealed that rmpA (odds ratio [OR], 28.85), Acute Physiologic and Chronic Health Evaluation (APACHE) II score ≥20 (OR, 8.08), and septic shock (OR, 4.33) were statistically significant predictors of metastatic infection. Metastatic infection (OR, 6.73), severity of disease (APACHE II score ≥16; OR, 11.82), septic shock (OR, 8.30), acute respiratory failure (OR, 69.92), and gas formation revealed on imaging (OR, 13.26) predicted mortality. Pigtail drainage protected against both metastatic infection (OR, 0.25) and mortality (OR, 0.14). Conclusion. Management of primary liver abscess caused by K. pneumoniae with use of first-generation cephalosporins and percutaneous drainage was associated with low rates of mortality, metastatic infection, and complications. These rates are comparable to those reported for third-generation cephalosporins.

Original languageEnglish
Pages (from-to)642-650
Number of pages9
JournalClinical Infectious Diseases
Volume47
Issue number5
DOIs
Publication statusPublished - Sep 1 2008
Externally publishedYes

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Liver Abscess
Klebsiella pneumoniae
Odds Ratio
Mortality
Infection
Cephalosporins
Septic Shock
Drainage
Cefazolin
Respiratory Insufficiency
Endophthalmitis
Klebsiella
Health
Acute Disease
Meningitis
Hospitalization
Chronic Disease
Gases
Morbidity

ASJC Scopus subject areas

  • Immunology

Cite this

Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. / Lee, Susan Shin Jung; Chen, Yao Shen; Tsai, Hung Chin; Wann, Shue Ren; Lin, Hsi Hsun; Huang, Chun Kai; Liu, Yung Ching.

In: Clinical Infectious Diseases, Vol. 47, No. 5, 01.09.2008, p. 642-650.

Research output: Contribution to journalArticle

Lee, Susan Shin Jung ; Chen, Yao Shen ; Tsai, Hung Chin ; Wann, Shue Ren ; Lin, Hsi Hsun ; Huang, Chun Kai ; Liu, Yung Ching. / Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. In: Clinical Infectious Diseases. 2008 ; Vol. 47, No. 5. pp. 642-650.
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abstract = "Background. Primary liver abscess caused by Klebsiella pneumoniae is an infection that is emerging worldwide and that is associated with severe morbidity and considerable mortality. Methods. A retrospective analysis of 110 episodes of primary liver abscess caused by K. pneumoniae that required hospitalization during 2001-2002 was conducted to identify predictors of metastatic infection, mortality, and the efficacy of first-generation cephalosporins and percutaneous drainage. The potential role of Klebsiella rmpA and magA genes was also evaluated. Results. The study included 59 men and 51 women, with a mean age of 61.8 years. Diabetes was noted in 67 patients (60.9{\%}). Metastatic infection occurred in 17 patients (15.5{\%}), with meningitis accounting for 11 patients (64.7{\%}) and endophthalmitis accounting for 4 patients (23.5{\%}). The overall mortality rate was 10.0{\%} (11 patients). Most of the severe complications occurred within the first 3 days after hospital admission. Ninety-two patients (83.6{\%}) received treatment with cefazolin for >3 days. Four patients (4.3{\%}) of the group who received cefazolin had metastatic infection, 1 patient (1.1{\%}) experienced septic shock, and 3 (3.3{\%}) experienced acute respiratory failure. Five (5.4{\%}) of those 92 patients died. Multivariable analysis revealed that rmpA (odds ratio [OR], 28.85), Acute Physiologic and Chronic Health Evaluation (APACHE) II score ≥20 (OR, 8.08), and septic shock (OR, 4.33) were statistically significant predictors of metastatic infection. Metastatic infection (OR, 6.73), severity of disease (APACHE II score ≥16; OR, 11.82), septic shock (OR, 8.30), acute respiratory failure (OR, 69.92), and gas formation revealed on imaging (OR, 13.26) predicted mortality. Pigtail drainage protected against both metastatic infection (OR, 0.25) and mortality (OR, 0.14). Conclusion. Management of primary liver abscess caused by K. pneumoniae with use of first-generation cephalosporins and percutaneous drainage was associated with low rates of mortality, metastatic infection, and complications. These rates are comparable to those reported for third-generation cephalosporins.",
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T1 - Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess

AU - Lee, Susan Shin Jung

AU - Chen, Yao Shen

AU - Tsai, Hung Chin

AU - Wann, Shue Ren

AU - Lin, Hsi Hsun

AU - Huang, Chun Kai

AU - Liu, Yung Ching

PY - 2008/9/1

Y1 - 2008/9/1

N2 - Background. Primary liver abscess caused by Klebsiella pneumoniae is an infection that is emerging worldwide and that is associated with severe morbidity and considerable mortality. Methods. A retrospective analysis of 110 episodes of primary liver abscess caused by K. pneumoniae that required hospitalization during 2001-2002 was conducted to identify predictors of metastatic infection, mortality, and the efficacy of first-generation cephalosporins and percutaneous drainage. The potential role of Klebsiella rmpA and magA genes was also evaluated. Results. The study included 59 men and 51 women, with a mean age of 61.8 years. Diabetes was noted in 67 patients (60.9%). Metastatic infection occurred in 17 patients (15.5%), with meningitis accounting for 11 patients (64.7%) and endophthalmitis accounting for 4 patients (23.5%). The overall mortality rate was 10.0% (11 patients). Most of the severe complications occurred within the first 3 days after hospital admission. Ninety-two patients (83.6%) received treatment with cefazolin for >3 days. Four patients (4.3%) of the group who received cefazolin had metastatic infection, 1 patient (1.1%) experienced septic shock, and 3 (3.3%) experienced acute respiratory failure. Five (5.4%) of those 92 patients died. Multivariable analysis revealed that rmpA (odds ratio [OR], 28.85), Acute Physiologic and Chronic Health Evaluation (APACHE) II score ≥20 (OR, 8.08), and septic shock (OR, 4.33) were statistically significant predictors of metastatic infection. Metastatic infection (OR, 6.73), severity of disease (APACHE II score ≥16; OR, 11.82), septic shock (OR, 8.30), acute respiratory failure (OR, 69.92), and gas formation revealed on imaging (OR, 13.26) predicted mortality. Pigtail drainage protected against both metastatic infection (OR, 0.25) and mortality (OR, 0.14). Conclusion. Management of primary liver abscess caused by K. pneumoniae with use of first-generation cephalosporins and percutaneous drainage was associated with low rates of mortality, metastatic infection, and complications. These rates are comparable to those reported for third-generation cephalosporins.

AB - Background. Primary liver abscess caused by Klebsiella pneumoniae is an infection that is emerging worldwide and that is associated with severe morbidity and considerable mortality. Methods. A retrospective analysis of 110 episodes of primary liver abscess caused by K. pneumoniae that required hospitalization during 2001-2002 was conducted to identify predictors of metastatic infection, mortality, and the efficacy of first-generation cephalosporins and percutaneous drainage. The potential role of Klebsiella rmpA and magA genes was also evaluated. Results. The study included 59 men and 51 women, with a mean age of 61.8 years. Diabetes was noted in 67 patients (60.9%). Metastatic infection occurred in 17 patients (15.5%), with meningitis accounting for 11 patients (64.7%) and endophthalmitis accounting for 4 patients (23.5%). The overall mortality rate was 10.0% (11 patients). Most of the severe complications occurred within the first 3 days after hospital admission. Ninety-two patients (83.6%) received treatment with cefazolin for >3 days. Four patients (4.3%) of the group who received cefazolin had metastatic infection, 1 patient (1.1%) experienced septic shock, and 3 (3.3%) experienced acute respiratory failure. Five (5.4%) of those 92 patients died. Multivariable analysis revealed that rmpA (odds ratio [OR], 28.85), Acute Physiologic and Chronic Health Evaluation (APACHE) II score ≥20 (OR, 8.08), and septic shock (OR, 4.33) were statistically significant predictors of metastatic infection. Metastatic infection (OR, 6.73), severity of disease (APACHE II score ≥16; OR, 11.82), septic shock (OR, 8.30), acute respiratory failure (OR, 69.92), and gas formation revealed on imaging (OR, 13.26) predicted mortality. Pigtail drainage protected against both metastatic infection (OR, 0.25) and mortality (OR, 0.14). Conclusion. Management of primary liver abscess caused by K. pneumoniae with use of first-generation cephalosporins and percutaneous drainage was associated with low rates of mortality, metastatic infection, and complications. These rates are comparable to those reported for third-generation cephalosporins.

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