ABSTRACT
In recent years, Klebsiella pneumoniae (KP) has emerged as the predominant cause of pyogenic liver abscess in Asia. KP—as the causative microorganism in other visceral organ abscesses—is less described. In this study, we seeked to describe the clinical characteristics of KP visceral organ abscesses in our institution and evaluated the prescription practices of physicians with regard to antibiotic therapy. Materials and Methods: A retrospective analysis of patients with culture positive (blood or abscess aspirate) KP visceral organ abscesses from May 2014 to April 2016 requiring hospitalisation in Changi General Hospital was conducted. Results: A total of 140 adult patients with KP visceral organ abscesses were identified. The commonest site of involvement was the liver (77.9%), followed by genitourinary tract (20.7%). Diabetic patients were more likely to have liver abscesses, genitourinary abscesses, abscesses in 2 or more organs, genitourinary disease with abscess formation outside of the genitourinary tract, and endovascular infection. Patients with extended spectrum beta-lactamase producing KP, were more likely to have an obstructive lesion related to the site of the abscess. Overall mortality rate was 7.1%. Amongst survivors, the mean total duration of parenteral antimicrobial therapy was 2.5 weeks before switching to oral antimicrobial agents. Conclusion: Genitourinary tract is the commonest extra-hepatic site for visceral organ abscess in KP infections. Parenteral to oral switch of antimicrobial agents appears to be a safe and effective treatment option.
Klebsiella pneumoniae (KP) liver abscesses were first described in the 1980s in Taiwan.1 Consequently, KP emerged as the predominant cause of pyogenic liver abscess in various other countries in East and Southeast Asia. Metastatic infections involving the lung, eye, central nervous system, musculoskeletal system and urinary system have been described.2-4 Diabetes mellitus is a major risk factor for the development of KP liver abscesses and is associated with metastatic complications especially for non-K1/K2 strains.5,6 KP—as the causative microorganism in other visceral organs—is less described despite its propensity for tissue invasion.
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