Culture Sensitivity Patterns and Outcome of Liver Abscess in Children Admitted at a Tertiary Care Hospital in North India

Author(s): Navya Sree Manugu1, Narayana Lunavath2, Ramu Pedada3

Liver abscess has been recognised since the time of Hippocrates. Liver abscess is
defined as collection of purulent material in liver parenchyma. They are usually
caused by bacterial and amoebic infections, and less commonly, by other
protozoal and helminthic organisms. Amoebic liver abscess is the commonest
extra intestinal site of invasive amoebiasis which mainly affects infants and
young children. The incidence of pyogenic liver abscess is much higher among
children in developing countries than those in developed countries. The purpose
of this study was to evaluate culture sensitivity pattern (Blood & Pus) of liver
abscess in children.
This prospective observational study was conducted in the Department of
Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August
2017. This study has got Institutional Ethics Committee approval (Regd No:
IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted
with liver abscess (included consecutively) were enrolled after considering
inclusion and exclusion criteria. Written and informed consent was taken from
parents/guardians of children. Their clinical characteristics, radiological features,
laboratory data, clinical management, and outcomes were analysed.
In our study, out of 70 patients, 3.2 % patients showed growth in the blood
culture. Organsims isolated were Methicillin resistant Staphylococcus aureus
(MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase
negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36
patients underwent aspiration of pus from the abscess. Out of 36 aspirated
cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no
acid fast bacilli was identified and no fungal culture showed growth of organism.
Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In
our study, all the 70 patients were started on empirical antibiotics. Out of 70
patients, surgical intervention was done in 36 patients. In our study all the
patients were started on empirical antibiotics according to hospital protocol.
Liver abscess should be considered in children presenting with fever and
abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical
drainage has been the traditional mode of treatment of pyogenic liver abscess,
but this was replaced by IV broad-spectrum antibiotics and imaging-guided
percutaneous drainage.