Management of Pyogenic Liver Abscesses: Contemporary Strategies and Challenges.
Journal
Journal of clinical gastroenterology
ISSN: 1539-2031
Titre abrégé: J Clin Gastroenterol
Pays: United States
ID NLM: 7910017
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
medline:
16
8
2023
pubmed:
30
5
2023
entrez:
30
5
2023
Statut:
epublish
Résumé
Pyogenic liver abscesses (PLAs) are a suppurative infection of the hepatic parenchyma responsible for significant morbidity and mortality. PLAs are categorized into a variety of mechanisms: (1) via the portal vein, (2) through the biliary tract, (3) via the hepatic artery, (4) from trauma, (5) contiguously via direct extension, and (6) cryptogenically. The pathogenesis of PLA, which informs treatment, can often be discerned based on host factors, clinical presentation, and causative microorganisms. The Streptococcus anginosus group, hypervirulent Klebsiella pneumoniae , and multidrug-resistant gram-negative pathogens have emerged as microbiologically challenging organisms to treat. The identification of hypervirulent K. pneumoniae should prompt for assessment for metastatic spread and consideration of prolonged antimicrobial treatment. Abdominal imaging is indispensable in characterizing PLAs and facilitating source control interventions. Source control remains the most critical aspect of PLA management, followed by antimicrobial therapy. Empiric antibiotics for PLAs are informed by the suspected etiology of PLA formation. Duration of antimicrobial therapy is individualized and dependent on multiple components, including the success of achieving source control, host factors, mechanism of PLA development, and the illness course of the individual-factoring in clinical, biochemical, and radiographic parameters.
Identifiants
pubmed: 37249909
doi: 10.1097/MCG.0000000000001871
pii: 00004836-202309000-00005
doi:
Substances chimiques
Anti-Bacterial Agents
0
Polyesters
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
774-781Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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