Standardized outpatient management of Klebsiella pneumoniae liver abscesses.

Abstract

OBJECTIVES:

Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment.

METHODS:

We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality.

RESULTS:

All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02).

CONCLUSION:

The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.

• Authors: Douglas S G Chan, Sophia Archuleta, Ryan M Llorin, David C Lye, Dale Fisher
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 17 Issue 3 Pg. e185-8 (Mar 2013) ISSN: 1878-3511 [Electronic] Canada
• PMID: 23154175 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage, adverse effects, therapeutic use)
• Cohort Studies
• Community-Acquired Infections (drug therapy, microbiology)
• Female
• Hospitals, University
• Humans
• Klebsiella Infections (drug therapy, microbiology)
• Klebsiella pneumoniae (drug effects, isolation & purification)
• Liver Abscess (drug therapy, microbiology)
• Male
• Middle Aged
• Outpatients (statistics & numerical data)
• Prospective Studies
• Risk Factors
• Singapore
• Treatment Outcome