Klebsiella pneumoniae liver abscess in adults
Spontaneous primary bacterial liver abscess is increasingly caused by Klebsiella pneumoniae, particularly among adults from Asia or those with diabetes. K. pneumoniae is usually the sole pathogen and can be associated with metastatic infections, such as endophthalmitis, meningitis, septic pulmonary embolism and discitisWang, 2022.
Promptly and thoroughly assess the vision of adults diagnosed with K. pneumoniae liver abscess, because of the risk of endophthalmitisHussain, 2020.
Studies suggest an association between pyogenic liver abscess, especially those caused by K. pneumoniae, and colorectal cancerMohan, 2019. Consider a screening colonoscopy in adults with K. pneumoniae liver abscess.
For confirmed K. pneumoniae liver abscess in adults, use:
ceftriaxone 2 g intravenously, daily. ceftriaxone ceftriaxone ceftriaxone
For adults who have had a nonsevere (immediate or delayed) or a severe immediate1 hypersensitivity reaction to a penicillin, use ceftriaxone (at dosage above).
For adults who have had a severe delayed2 hypersensitivity reaction to a penicillin, ciprofloxacin or aztreonam are treatment options – seek expert advice.
Use the results of susceptibility testing to guide ongoing therapy.
Switch to directed oral therapy after 5 to 7 daysMolton, 2020 if all the following criteria are met:
- response to initial drainage is good
- the K. pneumoniae isolate is susceptible to ciprofloxacin
- the patient is not critically unwell
- metastatic infection involving the eye or central nervous system is not present.
If directed oral therapy for K. pneumoniae liver abscess is appropriate in adults, use:
ciprofloxacin orally ciprofloxacin ciprofloxacin ciprofloxacin
adult less than 75 kg: 500 mg 12-hourly
adult 75 kg or more: 750 mg 12-hourly.
The total duration of therapy (intravenous + oral) is usually 4 weeksMolton, 2020.
If the K. pneumoniae isolate is resistant to ciprofloxacin, use the results of susceptibility testing to guide ongoing therapy and seek expert advice.
If drainage was incomplete or not performed, 4 to 6 weeks of intravenous antibiotic therapy may be required. Ambulatory antimicrobial therapy may be appropriate for patients requiring longer durations of intravenous therapy.