Absceso hepático piógeno en pediatría: experiencia en un centro pediátrico de referencia

Abstract

Introduction: Liver abscess is a serious and an uncommon pediatric disease. Objective and Method: Description of 20 pediatric patients with liver abscess admitted in “Ricardo Gutierrez” Children’s Hospital, a Tertiary Reference Center of Buenos Aires, between 2009 and 2015. Results: The hospitalization rate was 35/100.000 admissions. Median age was 5 years old, male/female ratio 4/1. Five patients (25%) had predisposing factors. Median days at diagnosis were 12. Features: Fever 100%, prolonged fever 60%, abdominal pain 50%. The majority had leukocytosis and elevated CRP (median 160 mg/L). Liver enzymes were elevated in only 40% of patients. Ultrasonography detected 90%. A single abscess was observed in 60%; localized at right hepatic lobe, 65%. Purulent material was positive in 12/17 (70%) and bacteremia was present in 3/20 (15%). Wide empirical antibiotic therapy was used. Treatment shift was needed in four patients. The median days of intravenous antibiotics were 30 and the median of total treatment were 53. Surgical procedures were performed in 13/20 (65%). Conclusion: Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was the most frequent pathogen, especially in healthy children that associated skin or respiratory illness. Appropriate antibiotic treatment and eventual drainage allows good outcome without sequela or deaths.