akinohanayuki ブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

肝膿瘍 復習

肝膿瘍について、消化器科の医師から相談

血液培養2セット依頼
Klebsiella pneumoniae ESBLs 考慮
ドレナージ推奨
アメーバは?
そして、治療期間は…


UpToDate より

The clinical manifestations of pyogenic liver abscess usually include fever and abdominal pain; other symptoms may include nausea, vomiting, anorexia, weight loss and malaise.

The diagnosis of pyogenic liver abscess is confirmed by radiographic imaging (computed tomography or ultrasound) followed by aspiration and culture of the abscess material.

Most pyogenic liver abscesses are polymicrobial. Amebic abscess is best distinguished from pyogenic liver abscess by serology.

We recommend draining liver abscesses (Grade 1B). For drainage of abscesses ≤5 cm in diameter, we suggest needle aspiration rather than percutaneous catheter drainage (Grade 2C). Repeat needle aspiration may be required.

For drainage of abscesses >5 cm in diameter, we suggest percutaneous catheter drainage rather than needle aspiration (Grade 2B). Drainage catheters should remain in place until drainage ceases (usually up to seven days). 

We suggest surgical drainage (rather than percutaneous drainage) in the following circumstances (Grade 2C).

•Multiple abscesses (depending on number, position, and size)
•Loculated abscesses
•Abscesses with viscous contents obstructing drainage catheter
•Underlying disease requiring primary surgical management
•Inadequate response to percutaneous drainage within seven days

We recommend empiric parenteral antibiotic therapy pending culture and susceptibility results (Grade 1C). Suggested regimens are outlined in the table.

When there is a clinical response to therapy, oral antibiotics may be substituted for parenteral therapy (with the guidance of susceptibility testing) to complete a four to six week course of treatment. 

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