Bloodstream infection in patients with pyogenic liver abscess: Predictors, microbiological characteristics, and in-hospital outcomes

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OBJECTIVES: To investigate the predictors, microbiological characteristics, and in-hospital outcomes of bloodstream infection (BSI) in patients with pyogenic liver abscess (PLA). METHODS: We conducted a retrospective single-center cohort study of patients with PLA who underwent blood culture testing during hospitalization between January 2011 and December 2023. Clinical, laboratory, imaging, microbiological, treatment, and in-hospital outcome data were compared between patients with and without BSI. Multivariable logistic regression was used to identify independent predictors of BSI, and adjusted models were applied to examine the associations between BSI and in-hospital outcomes. RESULTS: A total of 347 patients with PLA were included, of whom 47 (13.5%) had BSI. Compared with non-BSI patients, those with BSI more frequently had systemic inflammatory response syndrome on admission (48.9% vs. 24.4%), higher procalcitonin levels (23.46 vs. 5.69 ng/mL), lower ALB levels (27.53 vs. 31.20 g/L), and gas-forming abscesses (27.7% vs. 10.3%). In multivariable analysis, jaundice (OR 8.17, 95% CI: 1.90-35.06) and higher procalcitonin (OR 1.02, 95% CI: 1.00-1.05) were independently associated with BSI. Klebsiella pneumoniae was the predominant pathogen in both blood and pus cultures. BSI was associated with greater treatment burden and worse in-hospital resource utilization, including more frequent use of ≥ 3 antibiotics (40.4% vs. 18.3%), longer hospital stay (19.34 vs. 14.74 days), and higher hospitalization costs (5399.21 vs. 3888.42 USD). Further stratification by combined blood and pus culture results showed that the Blood+/Pus+ subgroup had the highest inflammatory burden, treatment intensity, and hospitalization burden. CONCLUSION: BSI in PLA was associated with a greater inflammatory burden, increased treatment intensity, and worse in-hospital resource utilization. Combined interpretation of blood and pus culture results may help identify patients with greater clinical burden and support early risk stratification, closer inpatient monitoring, and timely reassessment of antimicrobial therapy in PLA.

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