Yonsei Med J.  2015 Mar;56(2):519-528. 10.3349/ymj.2015.56.2.519.

Clinical Features and Computed Tomography Characteristics of Non-Klebsiella pneumoniae Liver Abscesses in Elderly (>65 Years) and Nonelderly Patients

• Hsiang CW
• Liu CH
• Fan HL
• Ko KH
• Yu CY
• Wang HH
• Liao WI
• Hsu HH
• Chang WC

• KMID: 2070033
• DOI: http://doi.org/10.3349/ymj.2015.56.2.519

Abstract

PURPOSE
To compare the clinical and computed tomography (CT) appearances of liver abscesses caused by non-Klebsiella pneumoniae bacterial pathogens in elderly and nonelderly patients.
MATERIALS AND METHODS
Eighty patients with confirmed non-Klebsiella pneumoniae liver abscesses (non-KPLAs) were enrolled and divided into two age groups: elderly (age > or =65 years, n=42) and nonelderly (age <65 years, n=38). Diagnosis of non-KPLA was established by pus and/or blood culture. We compared clinical presentations, outcomes, and CT characteristics of the two groups, and performed multivariate analysis for significant variables and receiver-operating-characteristic analysis to determine the cutoff value of abscess diameter for predicting non-KPLA.
RESULTS
Elderly patients with non-KPLA were associated with a longer hospital stay (p<0.01). Regarding etiology, biliary sources had a strong association in the elderly group (p<0.01), and chronic liver diseases were related to the nonelderly group (p<0.01). Non-KPLAs (52.5%) tended to show a large, multiloculated appearance in the elderly group and were associated with bile duct dilatation (p<0.01), compared with the nonelderly group. The abscess diameter (cutoff value, 5.2 cm; area under the curve, 0.78) between the two groups was predicted. In multivariate analysis, underlying biliary tract disease [odds ratio (OR), 3.58, p<0.05], abscess diameter (OR, 2.40, p<0.05), and multiloculated abscess (OR, 1.19, p<0.01) independently predicted elderly patients with non-KPLA.
CONCLUSION
In the elderly patients with non-KPLA, a large, multiloculated abscess with a diameter greater than 5.2 cm was the predominant imaging feature.

Keyword

Liver abscess; Klebsiella pneumoniae; computed tomography; age

MeSH Terms

Adult
Aged
Aged, 80 and over
Bacterial Infections/*complications/*radiography
Female
Humans
Klebsiella Infections/microbiology
Klebsiella pneumoniae
Length of Stay
Liver Abscess/complications/microbiology/*radiography
Logistic Models
Male
Microscopy
Middle Aged
Multivariate Analysis
ROC Curve
Retrospective Studies
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 A 72-year-old woman with non-KPLA (caused by Enterococcus) who presented with fever and right upper quadrant pain for 7 days. An axial, contrast-enhanced CT image (A) shows a large (size: about 7.9 cm) abscess (arrows) in the dome. A coronal, contrast-enhanced reconstruction CT image (B) shows the abscess with a multiloculated appearance (arrow), which was associated with bile duct dilatation (star) and pneumobilia (arrowhead). Acute cholecystitis was found. This was the most common appearance of liver abscess in the elderly. Note also the mild bilateral pleural effusions and basal atelectasis. The patient received antibiotics and PCD drainage, and she was discharged after 25 days. KPLA, Klebsiella pneumoniae liver abscess; PCD, percutaneous catheter drainage.

• 

  Fig. 2 Receiver-operating-characteristic (ROC) analysis of the minimal diameter for abscesses in the elderly group. AUC, the area under the ROC curve.

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