Sepsis Secondary to Liver

Abscess

Muhammad Najmi Munawwar b. Mohd Hatta

Preceptor: Pn Syakiroh Ismail
 TABLE OF CONTENTS
01 02 03
MEDICAL & INITIAL
PATIENT
PRESENTATION &
DEMOGRAPHIC MEDICATION HISTORY DIAGNOSIS

04 05 06
REVIEW OF SYSTEM PROGRESS IN WARD PHARMACEUTICAL
CARE ISSUE
 PATIENT DEMOGRAPHIC

•• Mr.
Mr. AM
AM
•• Age:
Age: 54
54 years
years old
old
•• Race:
Race: Malay
Malay
•• Gender:
Gender: Male
Male
•• Date
Date of
of Admission:
Admission: 2/9/2022
2/9/2022
•• Work
Work as
as aa lorry
lorry driver
driver in
in
Penang
Penang
•• Lives
Lives alone
alone
 Initial presentation & past medical history

Chief complaint:
Underlying:
Shortness of breath x 2/7
 Diabetes mellitus
 Hypertension
History of present illness:
 Dyslipidaemia
 Feverish x 3/7
(Follow-up at KK Bayan Lepas)
 Chills & rigors x 3/7
 Loss of appetite x 3/7
 H/O Appendectomy 3-4
 Lethargic x 3/7
years ago
 Unproductive cough x 2/7
 H/O Admission to GHPP on
 Right-sided chest pain when
18/8/2022 for 5 days
coughing
 Dysuria x 2/7
 Past Medication History

KK Bayan Lepas (25/8/22 – HPP Discharge

24/10/22) Medication (22/8/22)

S/C Mixtard 16U BD T. Unasyn II/II BD x 35/7

T. Metformin 1 g BD
T. Simvastatin 40 mg ON
T. Perindopril 2 mg OD
T. Mecobalamin 500 mcg OD

NKDA/NKFA
Claimed to comply with medications
 REVIEW OF SYSTEM (ED)
Blood Pressure 127/52 mmHg

Respiratory rate 20/min

Pulse rate 102/min

Temperature 38⁰ C

Random blood sugar 29.0 mmol/l

SpO2 96% ↓RA

 Blood Pressure

3/9 4/9 5/9 6/9 7/9 8/9 9/9 10/9 11/9 12/9

106/61 116/83 120/67 129/63 126/72 113/77 115/76 115/65 128/74 131/74

13/9 14/9 15/9 16/9 17/9 18/9 19/9 20/9

121/70 133/68 122/70 135/76 131/66 148/82 130/84 146/90

 Body Temperature
40
39.5
39
38.5
°C

38
37.5
37
36.5
36
35.5
35
ep ep ep ep ep ep ep ep ep ep ep ep ep ep ep ep ep ep
S S S S S S S S S S S S S S S S S S
3- 4- 5- 6- 7- 8- 9- 1 0- 1 1- 1 2- 1 3- 1 4- 1 5- 1 6- 1 7- 1 8- 1 9- 2 0-

Date
 Pulse
140 133
127
123
120 118
109
105 104 106
102 101 103
Bpm

100 98 96 94 98
92 91 92

80

Pulse
60

40
p p p p p p p p p p p p p p p p p p
-Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se -Se
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
 Laboratory Investigation
FBC

Ref 2/9 3/9 4/9 5/9 7/9 10/9 12/9 13/9 14/9 19/9

4-11 x
TWBC 23.69 23.19 24.17 19.53 13.85 23.99 19.76 24.26 28.79 13.65
10/L
11.5-16.5
Hb 7 6.4 7.3 6.1 7.3 6.7 7.1 7.3 8.4 8.2
g/ 100mL
Platele 150-400 x
417 336 353 389 361 401 430 363 394 429
t 10/L
Renal Profile

Ref
2/9 3/9 4/9 5/9 7/9 10/9 12/9 14/9 16/9
(mmol/L)

Urea 1.7-8.3 14.6 13.6 13.6 10.2 7.3 6.8 6.2 6.5 6.7

Na+ 135-145 130 152 138 134 137 137 139 140 136

K+ 3.5-5.0 4.7 3.8 3.7 3.6 3.3 3.3 3.8 3.3 3.9

SCr 64-122 129 113 136 102 109 104 91 91 86

CrCl 105-150 41 47 39 52 48 51 58 58 61

Ca2+ 2.1-2.6 1.9 1.87 2.3

Mg2+ 0.7-1.3 0.8 0.93 0.96

PO4- 0.8-1.45 0.37 0.37 0.96

 LFT

Ref 2/9 3/9 4/9 5/9 7/9 10/9 12/9 14/9 16/9

35-50
Albumin 24 22 23 23 23 20 21 20 18
g/L
<20
T.Bilirubin 12 13 14 12 9 10 14 7
umol/L
66-87
T.Protein 69 61 66 69 70 63 67 65 61
g/L
53-141
ALP 717 598 835 742 862 1152 1052 848 728
u/L

ALT < 32 u/L 48 74 202 120 83 55 65 35 24

AST <37 u/L 427 77 74 64 108 24 26

VBG

Ref 2/9 4/9 12/9

pH 7.35-7.45 7.309 7.291 7.33

35-45 mmHg 35.1 45.9 46.2

pCO2

38-44 mmHg 39.9 95 28.8

pO2

22-29 mmol/L 17.6 22.1 24.5

HCO3

O2 Sat 70-80 % 66.9 97.5 50.7

 Others

Ref 2/9 5/9 10/9 14/9 16/9 19/9

LDH 0-248 u/l 142 270

219.2 145.7 101.5 81.9

CRP < 5 mg/L 44.6
DXT
DXT (mmol/L)
Date \ Time 8 am 12 pm 5 pm 10 pm
16 16
4/9
Actrapid 8U Insulatard 12U
17.3 11.9 11.7 17
5/9
Actrapid 8U Actrapid 12U Actrapid 12U Insulatard 17U
17.7 9 4 18.9
6/9
Actrapid 12U Actrapid 14U Withhold Insulatard 20U
20.6 11.8 10.7 17.3
7/9
Actrapid 14U Withhold (NBM) Actrapid 14U Insulatard 20U
14.9 11.4 3.9 14.5
8/9
Actrapid 14U Actrapid 14U Withhold Insulatard 20U
13.4 3.4 5 13.3
9/9
Actrapid 14U Withhold Refuse Insulatard 20U
12.4 8.4 13.7
10/9 -
Actrapid 16U Actrapid 16U Insulatard 22U
6.2 3.9 10.3 11.4
11/9
Actrapid 12U Withhold Actrapid 16U Insulatard 22U
DXT
DXT (mmol/L)
Date \ Time 8 am 12 pm 5 pm 10 pm
6.9 3.8 15.4 7.2
12/9
Actrapid 12U Withhold Withhold Insulatard 22U
5.8 2.6 4.1 11.3
13/9
Actrapid 12U Withhold Withhold Insulatard 22U
10.4 8.2 8.7
14/9 To U/S Room
Actrapid 12U Actrapid 12U Insulatard 22U
12.3 9.3 3.3 13.1
15/9
Actrapid 12U Actrapid 16U Withhold Insulatard 22U
7.0 5.0 15.5 13.8
16/9
Actrapid 12U Actrapid 16U Actrapid 16U Insulatard 22U
4.9 8.2 16.7 13.8
17/9
Withhold Actrapid 16U Actrapid 16U Insulatard 22U
8.5 7.8 7.8 5.8
18/9
Actrapid 12U Actrapid 16U Actrapid 16U Withhold
15.3 7.2 7.8 4.9
19/9
Actrapid 12U Actrapid 16U Actrapid 16U Withhold
 I/O Chart

Date Input Output Balance

3/9/22 800 400 400

4/9/22 2750 1000 1750
5/9/22 1850 600 1250
6/9/22 1100 1300 -200
7/9/22 2650 3700 -1050
8/9/22 1750 1000 750
9/9/22 850 1400 -550

10/9/22 850 1200 -350

11/9/22 950 750 250

 I/O Chart

Date Input Output Balance

12/9/22 1578 1500 78

13/9/22 1150 1050 100
14/9/22 900 600 300
15/9/22 800 1300 -500
16/9/22 850 1300 -450
17/9/22 950 1200 -280
18/9/22 1300 800 500

19/9/22 750 900 -150

 Drain Chart
(Pigtail for pleural
effusion)

Date Amount Remarks

Drainage
14/9/22 2000 cc Serous
15/9/22 1400 cc Serous
16/9/22 800 cc Serous
17/9/22 1100 cc Serous
18/9/22 350 cc Serous
19/9/22 400 cc Serous
20/9/22 700 cc Serous Target <50 cc for 2-3
days
 Culture & Sensitivity
S: 2/9
R: 6/9 Blood
S: Augmentin, Unasyn,
Klebsiella pneumoniae Cefuroxime, Cefazolin
S: 10/9 I: Ciprofloxacin
R: 13/9 Urine
Candida albicans
S:14/9
R:16/9 Blood
No growth
S:3/9
R:15/9 Melioidosis serology
Negative
 U/S & CT Results
5/9
1)
1) Small
Small liver
liver abscess
abscess
5/9 US
US Abdomen
Abdomen
2)
2) Renal
Renal parenchymal
parenchymal disease
disease
3)
3) Hepatomegaly
Hepatomegaly

9/9
9/9 (CT
(CT 1)
1) Multifocal
Multifocal liver
liver abscess
abscess
Hepatobilliary
Hepatobilliary
2)
2) Hypodense
Hypodense areaarea within
within prostate,
prostate, suggestive
suggestive prostatic
prostatic abscess.
abscess.
Disseminated melioidosis need to be considered.
Disseminated melioidosis need to be considered.
3)
3) Bilateral
Bilateral moderate
moderate pleural
pleural effusion
effusion
14/9
14/9 (USG
(USG
Percutaneous Multiple
Percutaneous Multiple liver
liver collection
collection seen.
seen. Not
Not
Drainage)
Drainage) feasible
feasible for
for percutaneous
percutaneous drainage
drainage

14/9
14/9 (USG
(USG Pigtail
Pigtail
Insertion)
Insertion)
Successful
Successful USG
USG pigtail
pigtail insertion
insertion of
of
right pleural effusion
right pleural effusion
 PROGRESS IN WARD
Day Patient’s Condition Plan

D1 Alert, conscious, pale, 1. IVD 1ø NS/1H

(3/9/2022) dehydrated 2. DXT QID
Saturday Lungs: Crepitations at right L2 3. U/S monitoring
4. IV Augmentin 1.2g TDS
DXT: 22.1 5. T. Azithromycin 500 mg OD
CRP: 219.2 6. Start Bco/Folate I/I OD
7. Start ferrous fumarate 400 mg
IMP: 1) TRO CAP OD
2) Uncontrolled DM 8. T. Vit C I/I OD
3) AKI Secondary to 1 9. KIV for transfusion if Hb
decreases in trend and patient
having symptoms.
 PROGRESS IN WARD
Day Patient’s Condition Plan
D1 S/B Dr Ng Shean Hong 1. Syp. Benadryl 15mL TDS
(3/9/2022) 2. DXT hourly
8.00 am Hepatomegaly 3 finger breaths 3. Continue IVI Insulin scale 4
CXR: Peripheral haziness 4. Transfuse 2ø PC today
DXT: 17 5. KIV U/S KUB if RP not improving
6. For endoscopy if patient keens
IMP: 1) CAP TRO liver abscess after discuss w/ family
2) Uncontrolled DM not in 7. Change to IV Rocephine 2g
DKA STAT & OD + IV Flagyl 500 mg
3) AKI Secondary to 1 TDS
4) Pseudohyponatremia 8. For u/s abdomen TRO liver
5) High ALP (717 u/L) TRO abscess
liver/bone pathology
6) Symptomatic MCHC
anaemia for investigation
(Hb:6.4)
 PROGRESS IN WARD
Day Patient’s Condition Plan
D1 S/B Dr Zachary 1. Start IV Fortum 2G QID
(3/9/2022) 2. Continue IVD 4øNS/24H
8.30 am P/A: Soft, hepatomegaly 2 finger breaths 3. Transfuse 1ø PC today
CXR: Left lower zone haziness 4. Off Rocephin & Flagyl
5. For U/s abdomen on Monday
IMP: 1) Sepsis secondary to CAP 6. Refer surgical if worsening abdomen
TRO liver abscess pain
2) Cover for melioidosis 7. T. Azithromycin 500 mg OD x 3/7
3) MCHC Anaemia TRO 8. DXT hourly
occult GI bleeding 9. Continue IVI Insulin scale 4
4) AKI secondary to 1
5) Mild transaminitis
6) Uncontrolled DM w/ ketosis

1.30 pm Patient looks stable, no bleeding tendency 1. Not on transfusion today d/t shortage of
PC
 PROGRESS IN WARD
Day Patient’s Condition Plan

D2 S/B Dr Aidil 1. Continue IV Fortum

(4/9/2022) 2g QID
Sunday Still having abdominal pain, 2. Trace culture
however, claimed improving, no 3. For U/S Abdomen
fever coming morning
4. Continue IVD
DXT:14.8 (On sliding scale 4øNS/24H
insulin) 5. Change to S/C
Insulatard 12U ON
& S/C Actrapid 8U
TDS
6. DXT QID
 PROGRESS IN WARD
Day Patient’s Condition Plan

D3 S/B Dr Furzanie 1. Reduce IV Fortum 2g TDS

(5/9/2022) 2. Increase S/C Actrapid 12U TDS
Monday Alert, no fever, claimed & S/C Insulatard 16U ON
pain improving 3. U/S Abdomen today
4. Off Azithromycin
DXT:16/16/17.3 5. Trace MOPD GHPP
6. Trace melioidosis serology
 PROGRESS IN WARD
Day Patient’s Condition Plan
D4 S/B Dr Ahmad 1. Continue IV Fortum (D4)
(6/9/2022) 2. Increase Insulatard 20U ON &
Tuesday DXT:17.2/11.9/11.7/17.7 Actrapid 14U TDS
No fever 3. To enquire radiologist regarding
Abdominal pain improving possibility for drainage
4. Transfuse 1ø PC today
5. Strict monitoring DXT
6. Refer surgical
2.45 pm Surgical review 1. Continue antibiotic
U/S evidence suggests: 2. For CT HBS coming morning
1) Small liver abscess 3. NBM at 4 am
2) Renal parenchymal 4. IVD 4øNS/24H once NBM
disease 5. Continue medical plan
3) Hepatomegaly
 PROGRESS IN WARD
Day Patient’s Condition Plan

D5 S/B Dr Ahmad 1. Start IV Augmentin

(7/9/2022) 1.2g STAT & TDS
Wednesday Blood C&S – K. Pneumoniae 2. ECHO inpatient
3. KNBM as per
-Currently, the patient is stable surgical
under RA 4. Trace blood
-On & Off Abdominal pain investigation
-Afebrile
-NBM for CT
 PROGRESS IN WARD
Day Patient’s Condition Plan
D6 S/B Dr Ahmad 1. Reduce IVD
(8/9/2022) 2øNS/24H
Thursday -Had temperature spike last night 2. Continue IV
-Improved oral intake Augmentin
-Had desaturation under RA last night - put on 3. Encourage orally
NPO2 4. ECHO inpatient
5. Continue surgical
IMP: 1) Sepsis secondary to liver plan
abscess
2) Cover for melioidosis (unlikely)
3) AKI secondary to 1
4) Transaminitis
 PROGRESS IN WARD
Day Patient’s Condition Plan

D7 S/B Dr Ahmad 1. To wean down NPO2 to RA if

(9/9/2022) SPO2 >98%
Friday -On & off abdominal pain & SOB 2. Trace formal report CT HBS later
-Afebrile 3. Reduce IVD 1øNS/24H
-Tolerate orally 4. Encourage oral intake
- CT HBS today 5. Continue surgical plan
6. Continue IV Augmentin 1.2g TDS
7. Monitor RP & LFT
8. DXT QID
9. Strict I/O Chart
10. Increase S/C Actrapid 16U TDS
& S/C Insulatard 22U ON
 PROGRESS IN WARD
Day Patient’s Condition Plan

D8 Surgical AM Review 1. Continue IV Augmentin 1.2g TDS

(10/9/2022) 2. Suggest medical for melioidosis
Saturday CT HBS – 1) Multifocal liver serology
abscess involving
segments III, V, VI, VII
2) Hypodense area
within
prostate, suggesting
of
prostate abscess.
Disseminated
melioidosis needs to
be considered.
 PROGRESS IN WARD
Day Patient’s Condition Plan

D9 Surgical AM Review 1. Discuss with radiologist on

(11/9/2022) Monday for percutaneous
Sunday -Comfortable under FMO2 drainage
-No fever, No SOB, No chest pain 2. Trace melioidosis serology
-Has temperature spike yesterday 3. Continue antibiotic as per
(38.5° C) medical
4. If another temperature spikes, to
repeat the septic workup
5. Continue medical plan
 PROGRESS IN WARD
Day Patient’s Condition Plan

D10 -Stable under FMO2 1. Change to NPO2

(12/9/2022) -Tolerate oral minimally 2. Continue IVD 1øNS/24H
Monday -On/off cough (non-productive) 3. Continue IV Augmentin 1.2g TDS
4. Trace melioidosis serology
5. Continue surgical plan
12.00 pm Surgical review 1. Continue medical plan
-Afebrile 2. Start C. Tramadol 50 mg TDS
-Still having abdominal pain but 3. Transfuse 1ø PC
reducing 4. Call back radiologist once Hb
optimized
Patient Hb: 7.1
Aim for Hb≥8 for percutaneous
drainage
 PROGRESS IN WARD
Day Patient’s Condition Plan

D11 S/B Dr Ahmad 1. Transfuse 1ø PC today

(13/9/2022) Hb: 7.1 -> 7.3 2. Trace melioidosis serology
Tuesday WBC: 19.76 -> 24.26 3. Start IV Cefepime 1g TDS
Body temp: 36.5 ° C 4. NPO3 3L/min
5. Keep SPO2 >95%
- SOB/ Chest pain 6. Continue IVD 1øNS/24H
- No fever 7. For USG percutaneous drainage
- Mild RHC pain as planned 14/9/2022
- No Nausea/ Vomit
 PROGRESS IN WARD
Day Patient’s Condition Plan

D12 S/B Dr Ahmad 1. Start IV Fluconazole 400mg

(14/9/2022) STAT & 200mg OD
Wednesday Urine C&S: Candida Albicans 2. Continue IV Cefepime
- Comfortable under NPO2 3. Trace C&S and melioidosis
-Afebrile serology
-No URTI symptoms/abdominal 4. Continue IVD 1øNS/24H
pain 5. For USG percutaneous drainage
at 10.00 am
 PROGRESS IN WARD
Day Patient’s Condition Plan

D13 S/B Dr Ahmad 1. Start Neb Combivent 4 Hourly &

(15/9/2022) Neb Salbutamol 6 Hourly
Thursday - Saturating under NPO2 2. Continue IV Cefepime
- Afebrile 3. Trace melioidosis serology and
- On/off cough pleural fluid
- Tolerate orally 4. Continue IVD 1øNS/24H
- USG Percutaneous Drainage – 5. Continue surgical plan
Multiple liver collections seen; 6. Keep over weekend
not feasible for percutaneous
drainage. Procedure postpone.
- USG Guided Pigtail Insertion –
Shows moderate pleural
effusion over right hemithorax
 PROGRESS IN WARD
Day Patient’s Condition Plan

D14 S/B Dr Hafizi 1. Trial off NPO2, Keep SPO2 >

(16/9/2022) 95%
Friday - No SOB 2. Continue antibiotic
- No Fever 3. Continue drain chart
- No Chest pain
- Melioidosis negative

IMP: 1) Sepsis secondary to liver

abscess
2) Right pleural effusion
3) HAP with bronchospasm
4) Transaminitis
5) MCHC Anaemia
 PROGRESS IN WARD
Day Patient’s Condition Plan

D15 S/B Dr Chuah 1. Continue Neb (Combivent,

(17/9/2022) Salbutamol 6 Hourly –
Saturday - No SOB alternatively)
- No Fever 2. Continue antibiotic
- No Chest pain 3. Trace blood C&S
 PROGRESS IN WARD
Day Patient’s Condition Plan

D16 S/B Dr Anusiaa 1. Keep right pigtail and to continue

(18/9/2022) drain chart
Sunday comfortable under NPO2 2. Off once output <50 cc for 2-3
no SOB days
no chest pain 3. Trial off NPO2
afebrile 4. Enhance oral intake
5. Strict I/O Chart
6. Continue IV Cefepime
7. Continue analgesia
8. Continue neb
9. Continue surgical plan – For
USG abdomen x 2/52 after
pigtail insertion (14/9/22)
 PROGRESS IN WARD
Day Patient’s Condition Plan
D17 S/B Dr Ahmad 1. Antibiotic de-escalate to IV
(19/9/2022) Augmentin 1.2g TDS
Monday comfortable under NPO2 2. Trial off NPO2, Keep SPO2 ≥
no SOB 95%
no chest pain 3. Continue IVD
afebrile 4. Continue drain chart
no URTI symptoms 5. Keep right pigtail
Melioidosis negative 6. Enhance orally
7. Continue surgical plan
12.16 pm S/B Dr Che Arif 1. For U/S abdomen 2/52 (to get a
date)
2. Continue antibiotic
3. Surgical review PRN
4. Inform surgical if discharge
 Medication in Ward
Drug Indication 3/9 4/9 5/9 6/9 7/9 8/9 9/9 10/9 11/9
IV Ceftazidime 2g Cover for Change dose
QID melioidosis
IV Ceftazidime 2g Cover for De-escalate to Augmentin
TDS melioidosis
T Azithromycin Cover for CAP

IV Augmentin Liver Abscess

1.2g STAT & TDS (K.Pneumoniae)

Drug Indication 12/9 13/9 14/9 15/9 16/9 17/9 18/9 19/9 20/9
IV Cefepime 1g Liver Abscess De-escalate
TDS (K.Pneumoniae)

IV Augmentin 1.2g Liver Abscess

TDS (K.Pneumoniae)

IV Fluconazole Candiduria
400mg STAT &
200mg OD
 Medication in Ward
Drug Indication 3/9 4/9 5/9 6/9 7/9 8/9 9/9 10/9 11/9 →
20/9
S/C Actrapid Uncontrolled
DM
S/C Insulatard Uncontrolled
DM
T. Vitamin C I/I OD Anaemia

T. B Co/Folate I/I OD Anaemia

T. Ferrous fumarate 400mg Anaemia

OD
 Medication in Ward
Drug Indication 12/9 13/9 14/9 15/9 16/9 17/9 18/9 19/9 20/9

C. Tramadol 50 mg TDS Pain

T. Glyprin 100 mg OD Primary prevention

CVS
T. Clopidogrel 75 mg OD Primary prevention
CVS
 PHARMACEUTICAL CARE ISSUES
Date PCI Recommendation/Plan Outcome
3/9/22 2.2 Inappropriate According to NAG, the dose for IV Accepted
dose Ceftazidime for melioidosis is (100-
120mg/kg/day) every 6-8 hours
IV Ceftazidime 2g
QID was given to Therefore, 120mg x 50 kg =
the patient for 6000mg/day (2g TDS)
melioidosis (50kg)
 PHARMACEUTICAL CARE ISSUES
Date PCI Recommendation/Plan Outcome
7/9/22 2.1 Suggest to de-escalate to IV Accepted
Inappropriate Augmentin 1.2 g TDS Monitor for
drug patient WBC,
body temp and
Blood C&S: CRP
K.Pneumoniae
 PHARMACEUTICAL CARE ISSUES
Date PCI Recommendation/Plan Outcome
12/9/22 2.4 Incomplete According to NAG, the duration of Accepted. To
duration for antibiotic for the liver abscess is confirm with the
antibiotic to between 4-6 weeks depending on radiologist first for
cover for liver the possibility of drainage drainage
abscess possibility.
 Discussion
Is there any alternative other than parenteral antibiotics for multiple liver
abscesses?

Yes, but the duration may be longer due to less sensitivity of K.Pneumoniae
towards ciprofloxacin. Based on one RCT study in Singapore, stepping down to
oral antibiotics after 5 days of effective intravenous antibiotics resulted in a non-
inferior rate of clinical cure at 12 weeks compared with continuing intravenous
antibiotics at a lower cost.
 Discussion
Why need a long duration of treatment (4-6 weeks)?

It needs a longer duration due to poor penetration of systemic antibiotics inside the abscess.
Surgical intervention as a source control remains the mainstay of liver abscess treatment
together with antibiotics. An abscess that is less than 3 cm in diameter can be treated with
antibiotic alone but multiple abscesses or more than 5 cm in diameter need drainage for the
antibiotic to be effective.
 Discussion
Relapse of K.Pneumoniae liver abscess.

The case of recurrent KLA is rare. There is a case report where a patient was discharge with
7 weeks of antibiotic treatment and insulin therapy for his diabetes mellitus. This patient had
a recurrent 6 years later presenting with poorly control blood glucose. They believed that the
DM is the main risk factor that enhanced the pathogenicity of the K.Pneumoniae.
 References
Lübbert C, Wiegand J, Karlas T. Therapy of Liver Abscesses. Visceral Medicine [Internet]. 2014 [cited 2022 Sep
21];30(5):334–41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513824/
‌
‌Chien Chuang et al, Fluoroquinolone Is an Alternative Treatment for Klebsiella Pneumoniae Liver Abscess and Its
Impact on Length of Stay. International Journal of Antimicrobial Agents, 106120 | 10.1016/J.ijantimicag.2020.106120,
2020)

Amoateng M, Osei-Bagyina P, Varughese R, Mathew A, Malhotra I. A Rare Case of Recurrent Klebsiella pneumoniae
Liver Abscess. Majumder S, editor. Case Reports in Infectious Diseases [Internet]. 2021 Apr 9 [cited 2022 Sep
21];2021:1–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053063/

Fluoroquinolones [Internet]. Nih.gov. National Institute of Diabetes and Digestive and Kidney Diseases; 2020 [cited
2022 Sep 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547840/

Molton et al., Oral vs Intravenous Antibiotics for Patients With Klebsiella pneumoniae Liver Abscess: A Randomized,
Controlled Noninferiority Study. Clinical Infectious Diseases | 10.1093/cid/ciz881 [Internet]. Sci-hub.ru. 2019 [cited
2022 Sep 21]. Available from: https://sci-hub.ru/https://pubmed.ncbi.nlm.nih.gov/31641767/
‌

‌
 THANKS!
CREDITS: This presentation template was created by Slidesgo, including icons by
Flaticon, infographics & images by Freepik

Please keep this slide for attribution

CREDITS: This presentation template was created by Slidesgo, including icons by
Flaticon, infographics & images by Freepik