Patient selection: primary liver abscess due to Klebsiella pneumoniae
Risk factors associated with metastatic infection (OR = odds ratio):
(1) presence of the capsule-associated virulence gene rmpA (OR 29)
(2) APACHE II score >= 20 (OR 8)
(3) septic shock, with systolic blood pressure < 90 mm Hg and need for vasopressors and/or intravenous rehydration (OR 4)
(4) failure to use a pigtail drain (OR 4)
where:
• The timing of the APACHE II score was not stated. It may be the maximum score.
Risk factors for death (OR = odds ratio for death):
(1) metastatic infection (OR 7)
(2) APACHE II score >= 16 (OR 12)
(3) septic shock (OR 8)
(4) acute respiratory failure, with need for intubation and mechanical ventilation (OR 70)
(5) gas formation (OR 13)
(6) failure to use a pigtail drain (OR 7)
The cumulative odds ratio for each outcome can be calculated as the product of the OR. The maximum cumulative product for metastatic infection is 3,712.
The maximum cumulative product for mortality is 4,280,640.
Aggressive management of the abscess with pigtail drainage and appropriate antibiotics can minimize adverse outcomes.
