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Demographic and clinical characteristics of patients

In our study, there were 353 patients diagnosed with PLA. As shown in Table 2, a total of 149 (42.21%) patients were ≥ 60 years old, and among the entire patient cohort, there were 212 (60.06%) men and 141 (39.94%) women. Furthermore, a history of smoking was present in 98 (27.76%) subjects, while a history of alcohol consumption was reported in 63 (17.85%) patients. Hypertension and diabetes mellitus had developed in 71 (20.11%) and 102 (28.90%) patients, respectively, while cardiovascular disease had manifested in 19 (5.38%). Cirrhosis was observed in only 11 cases (3.12%) and pleural effusion was documented in the medical records of 32 enrolled patients (9.07%). Pneumonia affected a total of 18 subjects (5.10%), while pericardial effusion on admission occurred rarely, with only two cases (0.57%). The predominant symptom observed in the patients was fever (87.82%), followed by chills (57.51%), abdominal pain (44.76%), and nausea or vomiting (22.66%). Furthermore, jaundice was present in 16 (4.53%) patients, while fatigue was reported by 60 (17.00%) subjects. On the day of admission, 178 (50.42%) patients showed an abnormal increase in leukocyte count. The mean abscess diameter was measured at 6.10 cm (range: 0.60–17.30), and the majority of patients (77.62%) developed a single abscess. The right hepatic lobe is the most common site of abscess formation in this cohort, accounting for 62.61% of cases, followed by the left hepatic lobe with 15.30%. In addition, bilateral abscesses were observed in 38 (10.76%) cases. Gas formation was also noted in 43 (12.18%) patients.

The results in Table 3 show that a total of 222 pus Cultures were collected, with 70 patients (31.53%) yielding negative findings. Among the positive results is Klebsiella pneumoniae And Escherichia coli were identified as the two most common pathogens in this study, 43.24% and 7.21%, respectively. In addition, a total of 166 blood culture samples were obtained, with negative results observed in 127 cases (76.51%). Remarkable, Klebsiella pneumoniae also appeared to be the most important pathogen among the positive blood cultures (13.25%), followed by Streptococci (3.01%). In Table 4, it was documented that percutaneous drainage was performed in 206 (58.36%) patients, while surgical drainage was performed in 49 (13.88%) and conservative treatment was given to 98 (27.76%) patients. Antibiotic therapy consisted of third-generation cephalosporins in 230 cases (65.16%), followed by carbapenems in 143 cases (40.51%). The majority of patients showed clinical improvement or were cured during hospitalization (73.09% and 20.68%, respectively), with a median time to temperature normalization of 6 days (range: 0-40). Finally, median patient costs ranged from $57.69 to $29,275.83 and retreatment within 3 months occurred in only four cases (1.13%).

Associations between history of biliary surgery and patient characteristics

In this study, a total of 353 patients were initially divided into two groups based on their history of biliary surgery (BS) and non-biliary surgery (non-BS). The non-BS group consisted of 262 patients, while the BS group consisted of 91 patients. Among the BS group, simple cholecystectomy was performed in 37 cases (40.66%), followed by biliary-intestinal anastomosis in 24.18% and cholecystectomy with examination of the common bile ducts in 14.29% (Table 1). As indicated in Table 2, no significant differences were observed in terms of age, most underlying conditions and all recorded symptoms between the BS group and the non-BS group. However, it was noted that a higher percentage of male patients (P = 0.004) with a history of biliary surgery, associated with comorbidities such as diabetes mellitus (P < 0.001) and pleural effusion (P <0.001). Furthermore, it is clear that the BS group had a higher prevalence of abnormalities in total bilirubin levels (P = 0.009) and APTT values ​​(P = 0.041). In addition, an interesting finding emerged indicating that gas-forming conditions are similar with regard to abscess size, number and location between both groups.

Table 3 shows that patients without a history of biliary surgery had a lower incidence of positive complications pusculture results (P= 0.012). Furthermore, cases with a history of biliary surgery were more likely to have multiple bacterial infections in both cases pusculture (P= 0.006) and blood culture (P= 0.047). Furthermore, the outcome of pusculture indicated that patients in the BS group had a higher prevalence of Escherichia coliinfection (P= 0.021), while the blood culture result showed that patients in the non-BS group had a higher prevalence of Klebsiella pneumoniainfection (P= 0.019).

In Table 4, treatment choice varied widely between patients with and without BS history (P<0.001). Although percutaneous drainage was the preferred treatment option for both groups, patients with a history of BS received more conservative treatment (45.05% vs. 21.76%) and underwent fewer surgical drainages (6.59% vs. 16.41%) . Regarding antibiotic use, patients with a history of BS were less likely to be prescribed third-generation cephalosporins and fluoroquinolones compared with those without a history of BS.P= 0.034 and P= 0.023 respectively). Furthermore, there were significant differences in outcomes between the two groups (P= 0.020). The non-BS group showed improvement in the condition in 22.14% of cases, while only 16.48% of cases in the BS group showed improvement. Conversely, treatments reported as ineffective were 12.09% in the latter group, compared to only 4.20% in the former group. However, no significant differences were observed between the two groups in terms of time required for temperature normalization, length of hospital stay, total costs incurred, and retreatment within 3 months. It is important to note that improvement refers to the consistent reduction or disappearance of hyperechoic spots, as seen in normal livers under ultrasound, and the disappearance of hypoechoic areas in the liver, along with relief of clinical symptoms and signs; However, some abnormalities may still persist. Uselessness implies no change in abnormal imaging features and clinical symptoms and signs, especially fever and hepatomegaly observed in our study.

Subgroup analysis in PLA patients with BS history

Patients with a history of biliary surgery were divided into two subgroups based on whether they had undergone bilioenteric anastomoses (BEA). 22 patients were included in the BEA group and 69 patients in the non-BEA group. The non-BEA group consisted of patients who had undergone other types of biliary surgery instead of bilioenteric anastomoses (Table 5). Although both groups showed similarities in age, gender, underlying conditions, symptoms and laboratory tests, the BEA group showed a higher incidence of diabetes mellitus.P<0.001). No significant variation was observed between the two groups in terms of abscess size, location and gas-forming state. However, there was a substantial difference in the number of abscesses between the groups. The BEA group showed mainly solitary lesions, surpassing the other group (95.45% vs. 66.67%, P= 0.008). No significant differences were found between the two groups in terms of treatment choice, although the non-BEA group showed a greater likelihood of choosing carbapenems compared to the BEA group.P= 0.041). Both groups also showed similar clinical outcomes, time taken for temperature normalization, length of hospital stay, total costs incurred during hospitalization and number of retreatments within 3 months (P= 0.056).

Effect of conservative treatment on PLA patients with BS history

The data in Table 4 show a significantly higher percentage of patients in the BS group who underwent conservative treatment compared to the other group. Therefore, we performed a comparative analysis between conservative and non-conservative treatments in patients with a history of BS, with the aim of conducting an in-depth investigation of the impact of conservative treatment on this patient population. In Table 6, no significant association was observed between receiving conservative treatment and the indicators of liver and kidney function, coagulation, complications, time for temperature normalization, hospital stay, total hospitalization costs, retreatment within 3 months, and cure or improvement of the patient under similar circumstances. age, gender and underlying conditions. However, within the BS group, patients who underwent conservative treatment were found to be less likely to have abnormally low white blood cell counts (P= 0.021) and low hemoglobin levels (P= 0.007).