Liver Abscess

Polymicrobial involvement is common, with E. coli and Klebsiella pneumoniae being the two most frequently isolated aerobic pathogens. Enterobacteriaceae are especially prominent when the infection is of biliary origin. Other organisms include Actinomyces spp., Eikenella corrodens, Yersinia enterocolitica, Salmonella typhi, and Brucella melitensis.

Anaerobes may be involved in at least half of cases of pyogenic liver abscess (5). The most prevalent anaerobes in liver abscess are anaerobic and microaerophilic streptococci (not true anaerobes), Fusobacterium spp., B. fragilis group, and pigmented Prevotella and Porphyromonas spp. A colonic source is usually the initial source of infection. Staphylococcus aureus abscesses usually result from hematogenous spread of organisms involved with distant infections, such as endocarditis. Streptococcus milleri has been associated with both monomicrobial and polymicrobial abscesses in patients with Crohn's disease. S. aureus and beta-hemolytic streptococci are also associated with trauma; Enterococcus spp., K. pneumoniae, and Clostridium spp. with biliary disease; and Bacteroides and Clostridium spp. with colonic disease (Table 1).

Amebic liver abscess is most often due to Entamoeba histolytica. Fungal abscesses primarily are due to Candida albicans and occur in individuals with prolonged exposure to antimicrobials, hematologic malignancies, solid-organ transplants, and congenital and acquired immunodeficiency. Abscesses due to Aspergillus spp. have been reported.

TABLE 1 Correlation Between the Microbiology of 48 Liver Abscesses and Predisposing Conditions (in parenthesis-

-number of abscesses)

Biliary disease

Colonic disease

Recent gastric

Hematogenous seeding (4)

Trauma (4)

Pancreatitis

or duodenal

Organisms isolated

Benign (5)

Malignant (5)

Benign (9)

Malignant (4)

(2)

surgery (7)

Unknown (8)

Total (48)

Aerobic

Alpha-hemolytic

streptococci

1

1

1

1

1

5

Beta-hemolytic

streptococci3

1

2

3

Enterococcus

spp.

4

2

1

1

8

Staphylococcus

aureus

1 (1)

3(1)

Escherichia coli

1 (1)b

3

2(1)

1 (1)

4(2)

11 (5)

Klebsiella pneumoniae

1

2(2)

1

1

5(2)

Pseudomonas

aeruginosa

1

1

2

Proteus mirabilis

1

1

2

Serratia marcescens

1

1

1

3

Subtotal

5

6(3)

4

5(1)

2(1)

6(1)

3(1)

7(2)

5

43 (9)

Anaerobic

Peptostreptococcus

spp.

2

3

3

1

1 (1)

1

1

3

3

18(1)

Microaerophilic

streptococci

2

2

1

1

3

1

1

1

12

Propionibacterium

acnes

1

1

1

3

Veillonella parvulla

1

1

1

3

Clostridium spp.

2

1

3

2(2)

1

1

10(2)

Fusobacterium spp.

2(1)

2

2

4(1)

10(2)

Bacteroides spp.

1

5

2(1)

1

2(1)

2(1)

13(3)

Prevotella spp.

1

1

1

1

4

Subtotal

7

6

13

9(4)

9(1)

3

10(1)

11 (2)

73 (8)

Total

12

12(3)

17

14(5)

11 (2)

11 (1)

6(1)

17(3)

16(2)

116 (17)

3 Group A (2 isolates), Group F (one isolate). b Organisms recovered from blood. Source: Ret. 5.

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