BACKGROUND/AIMS: Klebsiella pneumoniae (K. pneumoniae) has been emerging as the leading cause of liver abscess although the most common pathogen was Escherichia coli in the past. Our study was to clarify the significance of K. pneumoniae as a pathogen of pyogenic liver abscess. METHODS: We reviewed 157 cases of pyogenic liver abscess treated at Yeungnam University Hospital from 1996 to 2001. They were classified into two groups: K. pneumoniae group and non-K. pneumoniae group. The clinical presentations, characteristics of liver abscess, laboratory findings and the results of bacteriological studies were compared. RESULTS: The K. pneumoniae group included 60 (60.6%) cases among 99 cases with positive culture. We found higher incidence of alcoholics (45.0%) or diabetes millitus (35.0%) in K. pnemoniae group. Cryptogenic cause (61.7%) was the most frequent portal entry in K. pneumoniae liver abscess. On the other hand, in non-K. pneumoniae group, the cause of portal entry was usually the secondary (23.1%) following biliary disease (61.5%). Statistically, there was no significant difference in age, sex, symptom, characteristics of abscess, laboratory findings except total bilirubin level between the two groups. CONCLUSIONS: Liver abscess caused by K. pneumoniae has emerged as an important infectious disease with new clinical significance. When clinicians see pyogenic liver abscess in patients with alcoholics or diabetes millitus, K. pneumoniae should be considered first as a cause of liver abscess.
Aged ; Female ; Humans ; Klebsiella Infections/*diagnosis ; *Klebsiella pneumoniae ; Liver Abscess/diagnosis/*microbiology ; Male ; Middle Aged

Abscess/diagnosis* ; Cardiac Tamponade/etiology* ; Humans ; Klebsiella Infections/diagnosis* ; Klebsiella pneumoniae ; Mediastinal Diseases/diagnostic imaging*

No abstract available.
Aged ; Female ; Humans ; Klebsiella Infections/*diagnosis/microbiology ; Klebsiella pneumoniae/*enzymology/isolation & purification ; Pneumonia/*diagnosis/microbiology ; Turkey ; beta-Lactamases/*metabolism

A mycotic aneurysm is a localized, irreversible arterial dilatation resulting from destruction of the vessel wall by infection. Pathogens causing mycotic aneurysms include Gram-positive and -negative bacteria, mycobacteria, and fungi. Klebsiella pneumoniae is a common pathogen causing urinary tract infections, nosocomial pneumonia, soft tissue infection, pyogenic liver abscesses, and endophthalmitis, while mycotic aneurysms caused by K. pneumoniae are rare. Recently, the number of cases of endogenous K. pneumoniae endophthalmitis associated with K. pneumoniae-induced pyogenic liver abscesses has increased in Southern Asia, but there have been no reports of K. pneumoniae mycotic aneurysms accompanied by endophthalmitis. Here, we report the case of a man who had a K. pneumoniae mycotic aneurysm accompanied by endophthalmitis and, ultimately, lost sight in both eyes. The early diagnosis of associated endophthalmitis requires a high index of suspicion by the physician.
Aneurysm, Infected ; Aorta ; Asia ; Bacteria ; Dilatation ; Early Diagnosis ; Endophthalmitis ; Eye ; Fungi ; Glycosaminoglycans ; Klebsiella ; Klebsiella pneumoniae ; Liver Abscess, Pyogenic ; Pneumonia ; Soft Tissue Infections ; Urinary Tract Infections

BACKGROUND/AIMS: Despite the improvement of personal and social hygiene, pyogenic liver abscess is still a common disease. We compared the incidence, infection route, underlying disease and major complications between two different local hospitals. METHODS: We reviewed the clinical data of 100 patients with pyogenic liver abscess who were treated at Seoul and Guri Hanyang University Hospital from 1999 to 2003. RESULTS: There were 64 males and 36 females in the study group; they were aged from 19 to 94 years with a mean of 56.5 years. Every year 19 to 23 pyogenic liver abscess patients were admitted to both hospitals. The most common organism isolated was Klebsiella pneumoniae in both local hospitals. In the Seoul hospital, diabetes (40.9%) was most common associated condition. In the Guri hospital, biliary tract disease or a history of hepatobiliary surgery (54.2%) was the most common associated condition. Catheter drainage and/or percutaneous needle aspiration were established as the standard treatment modality. CONCLUSIONS: In both regional hospitals, the incidence of pyogenic liver abscess did not decrease and Klebsiella pneumoniae was the most common organism. Diabetes and biliary tract disease, including, previous hepatobiliary surgery, were the most identifiable underlying disease.
Adult ; Aged ; Aged, 80 and over ; English Abstract ; Female ; Humans ; Klebsiella Infections/complications/diagnosis/therapy ; Klebsiella pneumoniae ; *Liver Abscess, Pyogenic/complications/microbiology/therapy ; Male ; Middle Aged

BACKGROUND/AIMS: Endogenous endophthalmitis (EE) is rare. However, the visual outcome of patients with EE is very poor. Many cases of EE caused by Gram-negative bacterial infections have recently been reported. This study was conducted to explore the most frequent pathogens, diagnosis, and treatment outcomes of EE. METHODS: A retrospective analysis was carried out in 23 patients diagnosed with EE through clinical manifestations and ophthalmic examinations in three hospitals between January 2000 and April 2011. Samples from 23 patients with EE were analyzed microbiologically. RESULTS: Pathogens were identified in 18 (78%) of the 23 blood, liver aspirate, and/or vitreous humor samples. Klebsiella pneumoniae was the most frequent organism (13/23, 57%). Abdomino-pelvic imaging (21/23, 91%) was performed to evaluate the primary site of infection. The most common primary infection was liver abscess (14/23, 61%). Despite administration of intravenous antibiotics and intravitreal injection, only six of 23 patients showed improvements in visual acuity. Thirteen (57%) experienced worse visual acuity. Four (17%) were eventually enucleated. CONCLUSIONS: In patients diagnosed with EE, abdomino-pelvic CT is required to exclude the presence of liver abscess. If a liver abscess is identified, percutaneous drainage should be considered. Considering the rapid progression and poor prognosis of EE, early diagnosis and immediate management are vital. We currently suggest that empiric antibiotics for treatment of EE should have activity against Gram-negative bacilli such as K. pneumoniae.
Anti-Bacterial Agents ; Drainage ; Early Diagnosis ; Endophthalmitis ; Gram-Negative Bacterial Infections ; Humans ; Intravitreal Injections ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Pneumonia ; Prognosis ; Retrospective Studies ; Visual Acuity ; Vitreous Body

BACKGROUND/AIMS: Klebsiella pneumoniae is emerging as the leading cause for liver abscess although the most common pathogen was Escherichia coli in the past. Patients with diabetes mellitus are more likely to have a pyogenic liver abscess with gas forming infection; a gas forming pyogenic liver abscess carries a higher morbidity and mortality than the non-gas forming group. This study was conducted to clarify the clinical presentation and prognostic factors for pyogenic liver abscess in diabetic patients compared with non-diabetic patients. METHODS: Medical records of 140 cases of patients treated for pyogenic liver abscess from January 1995 through January 2004 were reviewed retrospectively in detail. RESULTS: Among 140 cases of pyogenic liver abscess, underlying diabetes was present in 26.4% (37/140). The clinical presentation between the two groups was not significantly different. The most common organism for the pyogenic abscess was K. pneumoniae in both groups. A gas forming liver abscess was discovered in only the diabetic liver abscess group, 6 of 37 patients (16%). CONCLUSIONS: K. pneumoniae was the most common organism cultured in both diabetic and non-diabetic liver abscess. Gas forming liver abscess was more common in diabetic patients than non-diabetic patients. Diabetic patients had more complications than non-diabetic patients.
Adult ; Aged ; *Diabetes Complications ; Female ; Humans ; Klebsiella Infections/complications ; Klebsiella pneumoniae ; Liver Abscess, Pyogenic/*complications/diagnosis/microbiology ; Male ; Middle Aged ; Prognosis

Although the incidence of purulent pericarditis has decreased significantly in the modern antibiotic era, purulent pericarditis remains a life-threatening disease. Therefore, a high index of clinical suspicion should be maintained to diagnose this life-threatening illness at an early stage. We report an extraordinary case of purulent pericarditis, caused by Klebsiella pneumoniae bacteremia, which developed during the recovery of septic shock with urinary tract infection. Despite of early diagnosis and pericardial drainage, in addition to adequate antibiotics, the patient subsequently developed multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicated from septic shock with bacteremia in the antibiotic era. Therefore, purulent pericarditis should always be considered as a possible complication, especially in patients with K. pneumoniae bacteremia and progressive cardiomegaly.
Anti-Bacterial Agents ; Bacteremia ; Cardiomegaly ; Drainage ; Early Diagnosis ; Humans ; Incidence ; Klebsiella ; Klebsiella pneumoniae ; Multiple Organ Failure ; Pericarditis ; Pneumonia ; Sepsis ; Shock, Septic ; Urinary Tract Infections

BACKGROUND: The overuse and misuse of antimicrobial agents and their resultant emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult .Therefore,a new system that separated prescribing and dispensing medicine began on July 1,1997 to prevent overuse and misuse of medicine.We studied to evaluate changes of antibiotic sensitivities to causative microorganisms of urinary tract infection 2 years before and after the new medical system. METHODS: During each 2 years before and after the new medical system,we analyzed antibiotic sensitivities of causative microorganisms for urinary tract infection among the 447 out-patients who visited a hospital in GangNeung.The diagnosis of urinary tract infection was based on greater than 105 CFU (Colony For Unit)per ml.urine. RESULTS: The most common pathogenic microorganisms as E.coli (76.5%),followed by Klebsiella pneumoniae (5.1%),and Proteus mirabilis (3.6%)in urine culture. A first generation cephalosporin,cephalothin,against E.coli, had more significant sensitivity after the introduction of the new medical system (52.6%)than before (33.9%),especially in the 80th decade (P=0.023) and in females (P<0.001).Also,trimethoprim/sulfamethoxazole against E.coli showed signifcant improving sensitivity (P=0.025). CONCLUSION: There was little change of antibiotic sensitivity of urinary tract infection in out-patients before and after the new medical system in cephalothin and trimethoprim/sulfamethoxazole against E.coli. The change of antibiotic sensitivities will require further observation for a longer term after the introduction of the new medical system.
Anti-Infective Agents ; Cephalothin ; Diagnosis ; Female ; Humans ; Klebsiella pneumoniae ; Outpatients* ; Prescriptions* ; Proteus mirabilis ; Urinary Tract Infections* ; Urinary Tract*

Emphysematous prostatic abscess is a very rare form of prostatitis. Emphysematous prostatic abscess due to Klebsiella pneumoniae may have a poor prognosis according to a few previous reports. We report a rare case of successfully treated emphysematous prostatic abscess with cystitis due to Klebsiella pneumoniae in a 50-yr-old man with 15-yr history of diabetes mellitus. The patient was referred to the emergency room of our hospital. The KUB film revealed gas shadows in the lower pelvic area suggestive of emphysematous cystitis or emphysematous prostatic abscess. The gas was mainly occupying the prostate and was also seen in the bladder on pelvic CT. The patient was successfully treated with long-term antibiotic use and additional percutaneous drainage of the abscess. Emphysematous prostatic abscess may be misdiagnosed as emphysematous cystitis due to the similar location of gas shadows on radiography. Computerized tomography and transrectal ultrasonography are helpful in making the diagnosis of emphysematous prostatic abscess. Appropriate use of effective antibiotics with drainage of pus is the best treatment. This case emphasizes the importance of timely and accurate diagnosis followed by appropriate treatment in emphysematous prostatic abscess in diabetic patients.
Abscess ; Anti-Bacterial Agents/therapeutic use ; Cystitis/diagnosis ; Diabetes Mellitus/complications ; Drainage ; Emphysema/diagnosis/*microbiology ; Human ; Klebsiella Infections/*diagnosis/drug therapy ; Klebsiella pneumoniae/*metabolism ; Male ; Middle Aged ; Prostate/*microbiology ; Prostatic Diseases/*diagnosis/microbiology/radiography