PYOGENIC LIVER-ABSCESSES - REVIEW OF 59 C ASES AND EXPERIENCE WITH IMIPENEM

Objectives. To study the different etiopathogenic, microbiological, cl inical, evolutive, and therapeutic aspects in patients with pyogenic l iver abscesses, with a special emphasis in the usefulness of imipenem- cilastatin therapy. Materials and methods, The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple absce sses) diagnosed at our institution in the last eleven years were studi ed. Results. The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%). The microorganisms responsible for these abscesses included E. coli, Bacte roides spp., and different streptococci, CT and/or abdominal echograph y were the diagnostic techniques most commonly used. Twenty-three pati ents were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and a ntibiotics, and 8 exclusively with antibiotics. Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics. Twelve patien ts died and 9 required admission at the ICU. With regard to patients t reated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage. Two patients treated wit h imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapse d. Conclusions. Imipenem can be a useful antibiotic in association wit h percutaneous or surgical drainage for the treatment of pyogenic live r abscesses.