Refers to single or multiple abscesses on abdominal US or CT; ~half are due to identifiable GI source
Surgical/radiology consultation for drainage. Send specimen for cultures and histopathology
Obtain blood cultures
Testing for amebiasis is recommended if no known predisposition to pyogenic liver abscess (e.g. biliary disease), particularly in those from/with recent travel to endemic areas (e.g. Africa, India)
Serology for Entamoeba histolytica can take up to 2 weeks; consult microbiology for molecular testing on stool/abscess fluid
Treatment duration is guided by response to therapy
AND
Use higher Metronidazole doses until amebiasis ruled out; do not use Pip/Tazo monotherapy empirically
Tailor antimicrobials to culture and sensitivities; long-term polymicrobial coverage is debatable
Potent oral therapies can be used; there is no need for prolonged IV treatment
with or without Metronidazole 500mg PO BID
Usual Organisms
Less Common Organisms
Entamoeba histolytica
Unusual but Interesting Organisms
Yersinia enterocolitica, Fusobacterium necrophorum, Echinococcus sp., Bartonella sp.
Consult ID