ro13-9904 and Liver-Abscess

Topics: Aged; Aged, 80 and over; Ceftriaxone; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Humans; Liver Abscess; Male; Metronidazole; Salmonella typhi; Typhoid Fever

A cost-minimization analysis was conducted for Klebsiella pneumoniae liver abscess (KLA) patients enrolled in a randomized controlled trial which found oral ciprofloxacin to be non-inferior to intravenous (IV) ceftriaxone in terms of clinical outcomes. Healthcare service utilization and cost data were obtained from medical records and estimated from self-reported patient surveys in a non-inferiority trial of oral ciprofloxacin versus IV ceftriaxone administered to 152 hospitalized adults with KLA in Singapore between November 2013 and October 2017. Total costs were evaluated by category and payer, and compared between oral and IV antibiotic groups over the trial period of 12 weeks. Among the subset of 139 patients for whom cost data were collected, average total cost over 12 weeks was $16,378 (95% CI, $14,620-$18,136) for the oral ciprofloxacin group and $20,569 (95% CI, $18,296-$22,842) for the IV ceftriaxone group, largely driven by lower average outpatient costs, as the average number of outpatient visits was halved for the oral ciprofloxacin group. There were no other statistically significant differences, either in inpatient costs or in other informal healthcare costs. Oral ciprofloxacin is less costly than IV ceftriaxone in the treatment of Klebsiella liver abscess, largely driven by reduced outpatient service costs.Trial registration: ClinicalTrials.gov Identifier NCT01723150 (7/11/2012).

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Costs and Cost Analysis; Humans; Klebsiella pneumoniae; Liver Abscess

Klebsiella pneumoniae liver abscess (KLA) is emerging worldwide due to hypermucoviscous strains with a propensity for metastatic infection. Treatment includes drainage and prolonged intravenous antibiotics. We aimed to determine whether oral antibiotics were noninferior to continued intravenous antibiotics for KLA.. This noninferiority, parallel group, randomized, clinical trial recruited hospitalized adults with liver abscess and K. pneumoniae isolated from blood or abscess fluid who had received ≤7 days of effective antibiotics at 3 sites in Singapore. Patients were randomized 1:1 to oral (ciprofloxacin) or intravenous (ceftriaxone) antibiotics for 28 days. If day 28 clinical response criteria were not met, further oral antibiotics were prescribed until clinical response was met. The primary endpoint was clinical cure assessed at week 12 and included a composite of absence of fever in the preceding week, C-reactive protein <20 mg/L, and reduction in abscess size. A noninferiority margin of 12% was used.. Between November 2013 and October 2017, 152 patients (mean age, 58.7 years; 25.7% women) were recruited, following a median 5 days of effective intravenous antibiotics. A total of 106 (69.7%) underwent abscess drainage; 71/74 (95.9%) randomized to oral antibiotics met the primary endpoint compared with 72/78 (92.3%) randomized to intravenous antibiotics (risk difference, 3.6%; 2-sided 95% confidence interval, -4.9% to 12.8%). Effects were consistent in the per-protocol population. Nonfatal serious adverse events occurred in 12/72 (16.7%) in the oral group and 13/77 (16.9%) in the intravenous group.. Oral antibiotics were noninferior to intravenous antibiotics for the early treatment of KLA.. NCT01723150.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Middle Aged; Singapore

Klebsiella pneumoniae liver abscess is the most common etiology of liver abscess in Singapore and much of Asia, and its incidence is increasing. Current management includes prolonged intravenous antibiotic therapy, but there is limited evidence to guide oral conversion. The implicated K1/K2 capsule strain of Klebsiella pneumoniae is almost universally susceptible to ciprofloxacin, an antibiotic with high oral bioavailability. Our primary aim is to compare the efficacy of early (< one week) step-down to oral antibiotics, to continuing four weeks of intravenous antibiotics, in patients with Klebsiella liver abscess.. The study is designed as a multi-center randomized open-label active comparator-controlled non-inferiority trial, with a non-inferiority margin of 12%. Eligible participants will be inpatients over the age of 21 with a CT or ultrasound scan suggestive of a liver abscess, and Klebsiella pneumoniae isolated from abscess fluid or blood. Randomization into intervention or active control arms will be performed with a 1:1 allocation ratio. Participants randomized to active control will receive IV ceftriaxone 2 grams daily to complete a total of four weeks of IV antibiotics. Participants randomized to intervention will be immediately converted to oral ciprofloxacin 750 mg twice daily. At Week four, all participants will undergo abdominal imaging and be assessed for clinical response (CRP < 20 mg/l, absence of fever, plus scan showing that the maximal diameter of the abscess has reduced). If criteria are met, antibiotics are stopped; if not, oral antibiotics are continued, with reassessment for clinical response fortnightly. If criteria for clinical response are met by Week 12, the primary endpoint of clinical cure is met. A cost analysis will be performed to assess the cost saving of early conversion to oral antibiotics, and a quality of life analysis will be performed to assess whether treatment with oral antibiotics is less burdensome than prolonged IV antibiotics.. Our results would help inform local and international practice guidelines regarding the optimal antibiotic management of Klebsiella liver abscess. A finding of non-inferiority may translate to the wider adoption of a more cost-effective strategy that reduces hospital length of stay and improves patient-centered outcomes and satisfaction.. Clinical trials gov NCT01723150.

Topics: Administration, Intravenous; Administration, Oral; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Clinical Protocols; Cost-Benefit Analysis; Drug Administration Schedule; Drug Costs; Hospital Costs; Hospitals, Teaching; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Quality of Life; Research Design; Singapore; Time Factors; Treatment Outcome

The Enterobacter cloacae complex is responsible for a variety of infections in hospitalized patients and is resistant to β-lactam antibiotics owing to the expression of AmpC β-lactamase. We report emerging resistance in Enterobacter roggenkampii exposed to ceftriaxone and explore the mechanism underlying mutations responsible for this resistance.. Three strains were derived from different samples from one patient (blood and liver abscess fluid). Antimicrobial susceptibility was evaluated by standard broth microdilution, while ampC expression was determined via RT-PCR. Genetic relatedness was evaluated via pulsed-field gel electrophoresis (PFGE). Species identification and comparative genome analysis were performed via genome sequencing. Mutation rate testing and selection of AmpC-derepressed mutants were conducted to explore the mutation mechanism.. E. roggenkampii F1247 was susceptible to third-generation cephalosporins (3GCs); F95 and F1057, found in blood sample on day 11 and liver abscess drainage fluid on day 25, were resistant. ampC expression was 341- and 642-fold higher in F95 and F1057, respectively, than in F1247. Three isolates were the same PFGE and sequence types (ST1778) and were highly homologous (2 and 4 core genome single nucleotide polymorphism differences). Compared to F1247, F95 possessed a 575 bp deletion, including 537 bp of ampD, whereas F1057 harbored only one amino acid mutation (Leu140Pro in ampD). The mutation rates from F1247 exposure to cefotaxime, ceftazidime, ceftriaxone, piperacillin-tazobactam, and cefepime were (1.90 ± 0.21) × 10. E. roggenkampii may develop resistance in vivo and in vitro upon exposure to 3GCs and to a lesser extent to piperacillin-tazobactam. 3GCs should not be used as a monotherapy for E. roggenkampii infections. Therapy using cefepime or carbapenems may be preferred to piperacillin-tazobactam in the treatment of E. roggenkampii, especially if source control is difficult.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefepime; Ceftriaxone; Drug Resistance, Bacterial; Enterobacter; Enterobacter cloacae; Humans; Liver Abscess; Microbial Sensitivity Tests; Mutation; Piperacillin; Tazobactam

Actinomyces odontolyticus is not commonly recognized as a causative microbe of liver abscess. The detection and identification of A. odontolyticus in laboratories and its recognition as a pathogen in clinical settings can be challenging. However, in the past decades, knowledge on the clinical relevance of A. odontolyticus is gradually increasing. A. odontolyticus is the dominant oropharyngeal flora observed during infancy [Li et al. in Biomed Res Int 2018:3820215, 2018]. Herein we report a case of severe infection caused by A. odontolyticus in an immunocompromised patient with disruption of the gastrointestinal (GI) mucosa.. We present a unique case of a patient with human immunodeficiency virus infection who was admitted due to liver abscess and was subsequently diagnosed as having coinfection of A. odontolyticus, Streptococcus constellatus, and Candida albicans during the hospital course. The empirical antibiotics metronidazole and ceftriaxone were replaced with the intravenous administration of fluconazole and ampicillin. However, the patient's condition deteriorated, and he died 3 weeks later.. This report is one of the first to highlight GI tract perforation and its clinical relevance with A. odontolyticus infection. A. odontolyticus infection should be diagnosed early in high-risk patients, and increased attention should be paid to commensal flora infection in immunocompromised individuals.

Topics: Actinomyces; Ampicillin; Ceftriaxone; HIV Infections; Humans; Liver Abscess; Male

A 70-year-old man presented with acute wrist pain concerning for septic arthritis. Shortly thereafter, he developed acute monocular vision loss and was diagnosed with endogenous endophthalmitis. Subsequent imaging revealed numerous visceral abscesses and a mycotic abdominal aortic aneurysm. Cultures, in conjunction with the clinical syndrome, were strongly suggestive of hypervirulent

Topics: Administration, Intravenous; Aged; Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Endophthalmitis; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Escherichia coli; Female; Foreign Bodies; Humans; Intestinal Perforation; Liver Abscess; Middle Aged; Stomach; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Drainage; Emergency Service, Hospital; Humans; Liver Abscess; Male; Middle Aged; Point-of-Care Systems; Ultrasonography

Pyogenic liver abscesses (PLAs) are an uncommon, but potentially life threatening infection. We report a case of PLA due to Streptococcus constellatus, a member of the Streptococcus anginosus group (SAG) bacteria, commonly found as commensals of the oropharyngeal, gastrointestinal and genitourinary flora.. The patient, a 42-year-old man with no premorbidities, non-smoker and non-alcoholic, presented to our hospital with high-grade fever associated with chills and rigors and right upper quadrant pain of one month duration. Culture of the ultrasound-guided liver aspirate yielded a pure growth of S. constellatus subspecies constellatus identified by conventional biochemical tests. In a standard antimicrobial disk-diffusion test, the isolate was susceptible to cefepime, cefotaxime, ceftriaxone, vancomcyin, levofloxacin, clindamycin and linezolid. Treatment with parenteral ceftriaxone alongwith appropriate surgical management led to resolution of the abscess with no recurrence of infection at three months follow-up.. The pathogenic potential of SAG has generally been disregarded because of the commensal nature of these microorganisms; however, streptococci belonging to this group have been increasingly reported as relevant pathogens in abscesses and blood cultures. An underlying condition, such as diabetes, cirrhosis or cancer or some medical manipulation, such as dental extraction, acupuncture, or hemorrhoidectomy is associated with the majority of patients with SAG abscess. However, the present case highlights the need to include S. constellatus and other members of the SAG while investigating for etiology of PLA, even in immunocompetent adults.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Disk Diffusion Antimicrobial Tests; Humans; Immunocompetence; Liver Abscess; Male; Streptococcal Infections; Streptococcus constellatus

Liver abscess has formerly been a polymicrobial infection. Currently, liver abscess due to Klebsiella pneumoniae is increasingly reported, predominantly in Southeast Asia for unknown reasons. Liver abscess due to Klebsiella pneumonia has never been previously reported in Sri Lanka.. A 63-year-old Sinhalese man with diabetes mellitus and a poor glycemic control presented with fever, loose stools, and loss of appetite of 1 week's duration. An examination was unremarkable apart from a mild non-tender hepatomegaly. Investigations indicated a septic process with neutrophil leukocytosis, thrombocytopenia, and raised inflammatory markers with acute kidney injury. Sonography of his abdomen revealed a large liver abscess with two blood cultures positive for Klebsiella pneumoniae. He made a complete recovery following aspiration of the abscess and treatment with intravenously administered ceftriaxone.. Liver abscess due to Klebsiella pneumoniae is an emerging infection and most commonly reported from Southeast Asia. In Sri Lanka, further studies are necessary to understand the epidemiology and modes of spread. Furthermore, a high index of suspicion is essential as early detection is the key to successful treatment and prevention of complications.

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Middle Aged; Sri Lanka

Topics: Abdominal Pain; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Liver Abscess; Male; Metronidazole; Middle Aged; Nausea; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Treatment Outcome; Vomiting

Topics: Administration, Oral; Botulinum Toxins, Type A; Ceftriaxone; Diagnosis, Differential; Esophageal Achalasia; Female; Humans; Infusions, Intravenous; Injections, Intralesional; Liver Abscess; Metronidazole; Middle Aged; Streptococcal Infections; Streptococcus intermedius; Tomography, X-Ray Computed; Treatment Outcome

Topics: Ceftriaxone; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Laparoscopy; Liver Abscess; Microbial Sensitivity Tests; Middle Aged; Minocycline; Tigecycline

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drainage; Humans; Klebsiella pneumoniae; Liver Abscess; Male; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Diabetes Mellitus; Fermentation; Glucose; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver; Liver Abscess; Male; Taiwan; Tomography, X-Ray Computed

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drainage; Endophthalmitis; Humans; Injections, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Middle Aged; Psoas Abscess; Spondylitis; Tomography, X-Ray Computed

Actinomyces cardiffensis is an anaerobic, Gram-positive, non-spore-forming rod that was first identified by Hall et al. (Hall V. et al. (2002) J Clin Microbiol 40:3427-31). Here we report a case of bacteremia with liver and lung abscesses associated with A. cardiffensis. A 67-year-old man was hospitalized with fever and headache for 20 days. Blood culture revealed an Actinomyces species, which was ultimately identified as A. cardiffensis by 16S rRNA gene sequencing. A computed tomography scan of his chest showed small abscesses in his lung and liver. After a 3-week course of intravenous ceftriaxone, the patient showed rapid improvement. The patient was transitioned to oral amoxicillin for the remainder of his antibiotic treatment.

Topics: Actinomyces; Actinomycosis; Administration, Oral; Aged; Amoxicillin; Anti-Bacterial Agents; Blood; Ceftriaxone; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Hospitalization; Humans; Infusions, Intravenous; Liver Abscess; Lung Abscess; Male; Phylogeny; Radiography, Thoracic; RNA, Ribosomal, 16S; Sepsis; Sequence Analysis, DNA; Tomography, X-Ray Computed; Treatment Outcome

Vibrio cholerae non-O1 have caused several well-studied food-borne outbreaks of gastroenteritis and also have been responsible for sporadic cases of otitis media, wound infection, and bacteremia. Few cases of liver abscess caused by Vibrio cholerae non-O1 have been reported. A 73-year-old man with underlying diabetes mellitus was admitted with nausea, vomiting, dyspepsia and febrile sensation. We identified Vibrio cholerae non-O1 in his blood cultures and multiple hepatic microabscess on abdominal computed tomography. He was treated with systemic antibiotics and fluid therapy, but died due to septic shock on sixth day. We report here, a case of liver abscess with bacteremia due to Vibrio cholerae non-O1 in a patient with diabetes mellitus.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Humans; Liver Abscess; Male; Metronidazole; Shock, Septic; Tomography, X-Ray Computed; Vibrio cholerae non-O1; Vibrio Infections

Topics: Anti-Bacterial Agents; Ceftriaxone; Emergencies; Follow-Up Studies; Humans; Liver Abscess; Male; Middle Aged; Portal Vein; Staphylococcaceae; Thrombophlebitis; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

We present a case of a 42-year-old man with a solitary liver abscess and Gemella haemolysans bacteraemia. No other focus of infection was identified. The patient did not have any predisposing factors. He was treated with antibiotics for 6 weeks and the abscess was drained. He made a complete recovery.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Gemella; Gram-Positive Bacterial Infections; Humans; Liver Abscess; Male

Topics: Anti-Bacterial Agents; Biopsy, Needle; Ceftriaxone; Cysts; Diagnosis, Differential; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Treatment Outcome

Topics: Abdominal Abscess; Anti-Bacterial Agents; Antitubercular Agents; Ceftriaxone; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Middle Aged; Mycobacterium tuberculosis; Splenic Diseases; Tomography, X-Ray Computed; Tuberculosis, Hepatic; Tuberculosis, Splenic

Topics: Anti-Bacterial Agents; Bronchoscopy; Ceftriaxone; Diagnosis, Differential; Discitis; Follow-Up Studies; Humans; Liver Abscess; Lung Abscess; Male; Middle Aged; Pneumonia, Bacterial; Radiography, Thoracic; Streptococcal Infections; Streptococcus intermedius; Time Factors; Tomography, X-Ray Computed

A 64 years diabetic man presented with recurrent episodes of fever and abdominal pain. Ultrasonography revealed the presence of an abscess in the right lobe of the liver and a distended gall bladder with multiple calculi. Salmonella typhi was grown from the liver aspirate. Cholelithiasis may act as a predisposing factor for hepatic abscess formation in Salmonella carriers.

Topics: Ceftriaxone; Cephalosporins; Cholelithiasis; Diabetes Complications; Follow-Up Studies; Humans; Liver Abscess; Male; Middle Aged; Salmonella typhi; Time Factors; Typhoid Fever; Ultrasonography

Topics: Adult; Biopsy; Ceftriaxone; Cephalosporins; Follow-Up Studies; Humans; Liver; Liver Abscess; Male; Streptococcal Infections; Time Factors; Tomography, X-Ray Computed

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Kidney Diseases; Liver Abscess; Lung Diseases; Metronidazole; Nafcillin; Penicillins; Sepsis; Syndrome

Isolation of Edwardsiella tarda in humans has been associated with an asymptomatic carrier state as well as mild, self-limited diarrheal illness. Extraintestinal manifestations have included soft-tissue infections, meningitis, osteomyelitis, cholangitis, and sepsis. Only three cases of patients who had documented hepatic abscess due to E. tarda have been reported in the English-language literature; two patients died, and the third required a laparotomy and drainage. We report what is, to our knowledge, the first autochthonous case of hepatic abscess due to E. tarda in the United States and the first case that was successfully managed with antibiotic therapy alone.

Topics: Adult; Ceftriaxone; Cilastatin; Ciprofloxacin; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Imipenem; Liver Abscess; Male

Topics: Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Humans; Liver Abscess; Liver Abscess, Amebic; Male; Metronidazole; Middle Aged

Endophthalmitis is a well-recognized complication of intraocular surgery, penetrating ocular trauma and systemic infection. Metastatic bacterial endophthalmitis is rare. However, once it happens, the visual outcome is very poor. In order to prevent visual damage, early diagnosis and treatment is essential. Due to the blood-ocular barrier, intravitreal drug concentrations are low after systemic administration. Strong antibiotics with good penetration into the vitrous humor are needed to obtain adequate bactericidal concentrations. We report two cases with liver abscess complicated by septic events to the eye. One was uveitis, and the other was endophthalmitis. They were diagnosed early and were successfully treated with parenteral ceftriaxone and good vision was preserved.

Topics: Adult; Ceftriaxone; Endophthalmitis; Enterobacteriaceae Infections; Fluorescein Angiography; Humans; Klebsiella Infections; Liver Abscess; Male; Middle Aged; Sepsis; Sulfamethoxazole; Trimethoprim; Ultrasonography; Uveitis; Visual Acuity

Topics: Abscess; Bacteria; Ceftriaxone; Cholangitis; Female; Humans; Liver Abscess; Male; Middle Aged; Pancreatic Diseases; Pancreatitis; Peritonitis