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Dtsch Med Wochenschr 2017; 142(14): 1067-1074
DOI: 10.1055/s-0043-100540
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Pyogener Leberabszess: Erregerprofil und Konsequenzen für Diagnostik und Therapie

Pyogenic liver abscess: Changes of Organisms and Consequences for Diagnosis and Therapy
Alexander Mischnik
,
Winfried Vincenz Kern
,
Robert Thimme
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Publication History

Publication Date:
20 July 2017 (online)

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Abstract

Liver abscess is a rare but potentially fatal disease with mortality rates of 2 – 12 %. The spectrum of causative microorganisms varies across the world and is changing due to increasing worldwide travel activity. As a result, previously less frequent pathogens must increasingly be considered in the differential diagnosis. The most common pathogens of liver abscess are so-called abscess streptococci, anaerobes and Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. Certain clones among the Gram-negatives, typically among Klebsiella spp., harbour specific virulence factors and are therefore referred to as hypervirulent clones which spread worldwide. In any case, the causative agent should be identified before anti-infective treatment is initiated. Several pathogens such as Candida spp., Pseudomonas aeruginosa or Staphylococcus aureus are uncommon and only detected in a specific context. Various therapeutic regimens are available for anti-infective therapy. Usually an empirical therapy is started, combining mostly β-lactam antibiotics or quinolones with anaerobically active substances.

Aufgrund des stark angestiegenen internationalen Reiseverkehrs sind immer mehr seltene Erregertypen in die Diagnose bei infektiösen Erkrankungen einzubeziehen. So kann die Infektion durch Entamoeba histolytica und zunehmend auch seltenere bakterielle Erreger einschließlich Parasiten zu einem Leberabszess führen. Die Inzidenz liegt in der westlichen Welt zwar bei < 5/100 000 Einwohner pro Jahr, die Erkrankung kann aber trotz aller medizinischen Fortschritte drastisch verlaufen.

Schlüsselwörter

Leberabszess - Differenzialdiagnose - hypervirulente Klebsiella pneumoniae - perkutane Drainage - Amöbenleberabszess

Keywords

liver abscess - differential diagnosis - hypervirulent Klebsiella pneumoniae - percutaneous drainage - amoebic liver abscess
 

  • Literatur

  • 1 Romano G, Agrusa A, Frazzetta G. et al. Laparoscopic drainage of liver abscess: case report and literature review. Il Giornale di chirurgia 2013; 34: 180-182
    PubMedGoogle Scholar
  • 2 Civardi G, Filice C, Caremani M. et al. Hepatic abscesses in immunocompromised patients: ultrasonically guided percutaneous drainage. Gastrointest Radiol 1992; 17: 175-178
    CrossrefPubMedGoogle Scholar
  • 3 Seeto RK, Rockey DC. Pyogenic liver abscess. Changes in etiology, management, and outcome. Medicine (Baltimore) 1996; 75: 99-113
    CrossrefPubMedGoogle Scholar
  • 4 Mohsen AH, Green ST, Read RC. et al. Liver abscess in adults: ten years experience in a UK centre. QJM: monthly journal of the Association of Physicians 2002; 95: 797-802
    CrossrefPubMedGoogle Scholar
  • 5 Rahimian J, Wilson T, Oram V. et al. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis 2004; 39: 1654-1659
    CrossrefPubMedGoogle Scholar
  • 6 Huang CJ, Pitt HA, Lipsett PA. et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg 1996; 223: 600-607 ; discussion 607–609
    CrossrefPubMedGoogle Scholar
  • 7 Meddings L, Myers RP, Hubbard J. et al. A population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol 2010; 105: 117-124
    CrossrefPubMedGoogle Scholar
  • 8 Tsai FC, Huang YT, Chang LY. et al. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis 2008; 14: 1592-1600
    CrossrefPubMedGoogle Scholar
  • 9 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: 129-137 e121
    CrossrefPubMedGoogle Scholar
  • 10 Lam YH, Wong SK, Lee DW. et al. ERCP and pyogenic liver abscess. Gastrointest Endosc 1999; 50: 340-344
    CrossrefPubMedGoogle Scholar
  • 11 Heneghan HM, Healy NA, Martin ST. et al. Modern management of pyogenic hepatic abscess: a case series and review of the literature. BMC Res Notes 2011; 4: 80
    CrossrefPubMedGoogle Scholar
  • 12 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: 2257-2259
    PubMedGoogle Scholar
  • 13 Kao WY, Hwang CY, Chang YT. et al. Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study. Alimentary pharmacology & therapeutics 2012; 36: 467-476
    CrossrefPubMedGoogle Scholar
  • 14 Barnes PF, De Cock KM, Reynolds TN. et al. A comparison of amebic and pyogenic abscess of the liver. Medicine (Baltimore) 1987; 66: 472-483
    CrossrefPubMedGoogle Scholar
  • 15 Kurland JE, Brann OS. Pyogenic and amebic liver abscesses. Curr Gastroenterol Rep 2004; 6: 273-279
    CrossrefPubMedGoogle Scholar
  • 16 Lodhi S, Sarwari AR, Muzammil M. et al. Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. Tropical medicine & international health: TM & IH 2004; 9: 718-723
    CrossrefPubMedGoogle Scholar
  • 17 Keohane J, Dimaio CJ, Schattner MA. et al. EUS-guided transgastric drainage of caudate lobe liver abscesses. J Interv Gastroenterol 2011; 1: 139-141
    PubMedGoogle Scholar
  • 18 Jun CH, Yoon JH, Wi JW. et al. Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess. J Dig Dis 2015; 16: 31-36
    CrossrefPubMedGoogle Scholar
  • 19 Chemaly RF, Hall GS, Keys TF. et al. Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures. Diagn Microbiol Infect Dis 2003; 46: 245-248
    CrossrefPubMedGoogle Scholar
  • 20 Everts RJ, Heneghan JP, Adholla PO. et al. Validity of cultures of fluid collected through drainage catheters versus those obtained by direct aspiration. J Clin Microbiol 2001; 39: 66-68
    CrossrefPubMedGoogle Scholar
  • 21 Wong WM, Wong BC, Hui CK. et al. Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period. Journal of gastroenterology and hepatology 2002; 17: 1001-1007
    CrossrefPubMedGoogle Scholar
  • 22 Pagano L, Mele L, Fianchi L. et al. Chronic disseminated candidiasis in patients with hematologic malignancies. Clinical features and outcome of 29 episodes. Haematologica 2002; 87: 535-541
    PubMedGoogle Scholar
  • 23 Aikat BK, Bhusnurmath SR, Pal AK. et al. The pathology and pathogenesis of fatal hepatic amoebiasis--A study based on 79 autopsy cases. Trans R Soc Trop Med Hyg 1979; 73: 188-192
    CrossrefPubMedGoogle Scholar
  • 24 Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence 2013; 4: 107-118
    CrossrefPubMedGoogle Scholar
  • 25 Li W, Sun G, Yu Y. et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis 2014; 58: 225-232
    CrossrefPubMedGoogle Scholar
  • 26 Siu LK, Yeh KM, Lin JC. et al. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis 2012; 12: 881-887
    CrossrefPubMedGoogle Scholar
  • 27 Pichler C, Buchsel M, Rossen JW. et al. First report of invasive liver abscess syndrome with endophthalmitis caused by a K2 serotype ST2398 hypervirulent Klebsiella pneumoniae in Germany, 2016. New Microbes New Infect 2017; 17: 77-80
    CrossrefPubMedGoogle Scholar
  • 28 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: 485-490
    CrossrefPubMedGoogle Scholar
  • 29 Alvarez Perez JA, Gonzalez JJ, Baldonedo RF. et al. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess. American journal of surgery 2001; 181: 177-186
    CrossrefPubMedGoogle Scholar
  • 30 Lin YT, Liu CJ, Yeh YC. et al. Ampicillin and amoxicillin use and the risk of Klebsiella pneumoniae liver abscess in Taiwan. J Infect Dis 2013; 208: 211-217
    CrossrefPubMedGoogle Scholar
  • 31 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: 932-938
    CrossrefPubMedGoogle Scholar
  • 32 Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. Am J Roentgenol American journal of roentgenology 2007; 189: W138-W142
    PubMedGoogle Scholar
  • 33 Sudhamshu KC, Sharma D. Long-term follow-up of pyogenic liver abscess by ultrasound. Eur J Radiol 2010; 74: 195-198
    CrossrefPubMedGoogle Scholar