Klebsiella pneumoniae as leading cause of pyogenic liver abscess: Three years study in Southern Vietnam

BACKGROUND Pyogenic liver abscess (PLA) is increasingly recognized worldwide. In Asia, Klebsiella pneumoniae (K. pneumoniae ) has emerged as the predominant pathogen, yet contemporary data from Vietnam remain limited. AIM To determine the microbial spectrum of PLA and compare clinical, computed tomography (CT), management, and outcomes between K. pneumoniae and non-K. pneumoniae cases in Southern Vietnam. METHODS This retrospective cohort included adults with PLA managed at Nhan Dan Gia Dinh Hospital from June 2021 to June 2024. Of 123 cases, 17 were excluded (8 with unspecified Gram-negative bacilli, 9 without CT), leaving 106 patients (83 K. pneumoniae , 23 non-K. pneumoniae ). Data on demographics, comorbidities, presentation, laboratory, imaging, microbiology, treatment, and outcomes were analyzed using standard parametric/nonparametric and χ 2/Fisher tests (two-sided α = 0.05). RESULTS Mean age was 59.2 years, and 67.0% were male. Diabetes was more frequent in K. pneumoniae (55.4% vs 30.4%; P = 0.034). C-reactive protein was higher in K. pneumoniae but not significant (229.9 mg/L vs 185.0 mg/L; P = 0.069). Aspartate aminotransferase was significantly elevated (P = 0.048) and alanine aminotransferase borderline (P = 0.065). On CT, K. pneumoniae abscesses more often had irregular margins (P = 0.038) and heterogeneous architecture (P = 0.003). K. pneumoniae predominated in pus (71.9%) and blood (78.6%) cultures. Source-control and hospital stay were similar. Mortality was 10.4% overall, occurring only in K. pneumoniae (13.3% vs 0%). Older age predicted poorer survival (odds ratio = 0.95; P = 0.029). CONCLUSION In Southern Vietnam, K. pneumoniae predominates in PLA, characterized by distinctive CT features and higher mortality, emphasizing early recognition, pathogen-directed therapy, and timely image-guided drainage.