# Temporal Trends in Antimicrobial Resistance and Risk Factors in Patients with Pyogenic Liver Abscess: A Four-Year Cross-Sectional Study: Resistance Trends in Pyogenic Liver Abscess

## TL;DR

This study tracks antimicrobial resistance trends in liver abscess patients over four years, finding rising resistance in common bacteria like Klebsiella pneumoniae.

## Contribution

The study identifies temporal changes in antimicrobial resistance and risk factors in pyogenic liver abscess patients, emphasizing the need for updated treatment guidelines.

## Key findings

- Klebsiella pneumoniae remained the predominant pathogen in PLA cases over four years.
- Resistance to ceftriaxone and ciprofloxacin showed slight variations, while carbapenem resistance decreased.
- KPLA patients were more likely to have diabetes and cryptogenic origin compared to NKPLA patients.

## Abstract

Pyogenic liver abscess (PLA) is a serious liver infection, particularly
common in patients with immune deficiencies or chronic liver diseases. Given
the rising antimicrobial resistance in PLA-associated pathogens, this study
aimed to investigate the temporal trends in antimicrobial resistance and
associated risk factors in PLA patients over a four-year period.

This cross-sectional study was conducted at Tianjin First Center Hospital,
China, by reviewing the medical records of PLA patients from January 2019 to
December 2023. Patients were categorized into two groups: Klebsiella
pneumoniae (KPLA) and non-Klebsiella pneumoniae (NKPLA). Data on clinical
characteristics, laboratory results, imaging findings, microbiological
culture results, and antimicrobial susceptibility patterns were collected.
Temporal changes in antimicrobial resistance and associated risk factors
were analyzed.

A total of 328 patients were included, of whom 297 (90.5%) were infected with
Klebsiella pneumoniae (KPLA) and 31 (9.5%) with non-Klebsiella pathogens
(NKPLA). Over the four-year period, the number of PLA cases gradually
increased, with K. pneumoniae remaining the predominant pathogen. Resistance
to ceftriaxone (20% in 2019 and 20% in 2023) and ciprofloxacin (25% in 2019
and 23% in 2023) showed slight variations, while carbapenem resistance
decreased (imipenem: 7% in 2019 and 4% in 2023, meropenem: 6% in 2019 and 4%
in 2023). In comparing the KPLA and NKPLA groups, KPLA patients were more
likely to have diabetes (61.6% vs. 38.7%, P=0.01) and cryptogenic origin
(65.7% vs. 41.9%, P0.05). NKPLA cases had higher prevalence of hepatobiliary
disease (32.3% vs. 18.2%, P=0.04) and malignancy (19.4% vs. 8.8%, P=0.03).

This study highlights the increasing antimicrobial resistance in K.
pneumoniae and E. coli associated with PLA, underscoring the need for
updated local antibiograms and revised empirical therapy protocols.
Furthermore, the clinical and microbiological differences between KPLA and
NKPLA suggest that pathogen-specific and resistance-based stratification
should replace traditional classifications.