# Beyond the abscess: Klebsiella pneumoniae liver abscess combined with bloodstream infection

## TL;DR

This study examines patients with Klebsiella pneumoniae liver abscess who also have bloodstream infections, identifying risk factors and worse outcomes.

## Contribution

The study identifies SOFA score ≥2 as a risk factor and abscess size >10 cm as protective for KPLA combined with KP-BSI.

## Key findings

- KPLA/KP-BSI occurred in 27.9% of KPLA patients and was linked to worse outcomes like septic shock and higher mortality.
- A SOFA score ≥2 was an independent risk factor for KPLA/KP-BSI, while abscess size >10 cm reduced the risk.
- Patients with KPLA/KP-BSI had higher rates of organ dysfunction and longer hospital stays.

## Abstract

The clinical characteristics of Klebsiella pneumoniae liver abscess (KPLA) and Klebsiella pneumoniae bloodstream infection (KP-BSI) are often reported, while the risk factors for KPLA combined with KP bloodstream infection (KPLA/KP-BSI) among KPLA are largely unknown. Therefore, this study aimed to investigate the clinical characteristics, risk factors, and outcomes of patients with KPLA complicated by KP-BSI.

A retrospective study from May 2013 to October 2020 at a tertiary hospital compared KPLA patients with and without KP-BSI, analyzing clinical data.

Among all liver abscess cases during the study period, Klebsiella pneumoniae was the most common pathogen, accounting for 76.0% of isolates. Of 233 KPLA patients, 68.7% were male with a median age of 60.5 years. KPLA/KP-BSI occurred in 27.9%. Patients with KPLA/KP-BSI had higher male prevalence, abdominal surgery history, and higher APACHE II, SOFA, and CCI scores (p<0.05). Logistic regression showed SOFA score ≥ 2 (aOR 3.326) was a risk factor for KPLA/KP-BSI, while liver abscess size > 10 cm reduced the risk (aOR 0.144). KPLA/KP-BSI was associated with worse outcomes, including higher septic shock, acute kidney injury, transfusion rates, organ dysfunction, pneumonia, longer hospital stays, and higher mortality (all p<0.05).

Nearly one-third of patients with KPLA have concurrent KP-BSI. A SOFA score ≥2 is an independent risk factor, whereas abscess diameter >10 cm is protective. KPLA/KP-BSI is associated with significantly higher rates of septic shock, organ dysfunction, and in-hospital mortality, warranting heightened clinical attention.