Response to: Risk stratification for metastatic infection in invasive Klebsiella pneumoniae liver abscess syndrome: a call for standardized screening protocols

Dear Editor, Thank you for inviting us to respond to Dr Xie et al.’s insightful comments on our article entitled ‘Invasive liver abscess syndrome’.1 We also would like to thank Dr Xie et al. for their interest in the topic. We appreciate the opportunity to address these issues regarding this time-sensitive syndrome. Recently, Klebsiella pneumoniae infection has become a global health concern.1 Invasive liver abscess syndrome is a distinct life-threatening condition caused by hypervirulent K. pneumoniae that features as liver abscess combined with multiple sites of metastatic involvement (e.g. lung, brain, kidney and the eyes). Delayed treatment results in sepsis or death.1,2 Early recognition and reasonable management of this time-sensitive syndrome are essential for clinicians to prevent devastating metastatic infections.2,3 Providing standardized protocols is critical for patients with potential metastasis. In this regard, we agree with Dr Xie et al.’s suggestions. They proposed that immediate comprehensive screening was warranted in patients with any of the following high-risk features: (i) poorly controlled diabetes, (ii) smoking history, (iii) alcohol abuse or (iv) smaller abscess diameter.