Critical Care Management Considerations in Klebsiella pneumoniae Invasive Liver Abscess Syndrome: Case Reports and Narrative Review.

Authors

Jerry Chen, Caleigh Horan, Krishen Wadhwani, Pedro M Dammert, Elizabeth Sophy

Published in

Case reports in critical care. Volume 2026. Pages 5579095. Epub Jun 22, 2026.

Abstract

Klebsiella pneumoniae invasive liver abscess syndrome (ILAS) is an emerging disease characterized by liver abscess without biliary disease, often with multiorgan metastatic infection. It can cause severe critical illness with significant morbidity and disability. There remains limited literature and understanding of this syndrome in the United States.
This article aims to describe the clinical characteristics of hospitalized and critically ill patients with ILAS and providing management considerations for critical care clinicians.
Adult patients admitted to Scripps Health from Janurary 1, 2018 to April 1, 2024 were reviewed. Inclusion criteria required radiographic evidence of a liver abscess and cultures (blood or abscess) positive for K. pneumoniae. Data collected included demographics, symptoms and signs, laboratory and radiologic data, metastatic infection characteristics, treatment, mortality, and morbidity. Patient cases were described, and a narrative review describing clinical, therapeutic, and prognostic characteristics was conducted.
Six patients had ILAS. Mean age was 54.8 years, no immunosuppression (defined as underlying malignancy, drug-induced, or chronic infection), 83% had diabetes, 50% were male, and 50% were of Asian ethnicity. Liver abscesses were multilocular (50%), and all had percutaneous catheter drainage. Fifty percent of patients developed distant metastatic infections: emphysematous cystitis, pulmonary septic emboli, complicated parapneumonic pleural effusions, meningitis, ventriculitis, cerebral septic emboli, and endophthalmitis. These patients were younger, male, and had a higher rate of intensive care unit (ICU) admission and mechanical ventilation. Two patients required ICU admission with septic shock, diabetic ketoacidosis, respiratory failure, severe thrombocytopenia, and altered mental status. K. pneumoniae isolates were pansensitive except to ampicillin. There was no in-hospital mortality. The patient with meningitis and ventriculitis had full neurological recovery, and the patient with endophthalmitis had very poor residual visual acuity.
ILAS is an emerging disease that can cause severe critical illness with multiorgan involvement. Early identification of the disease and metastatic infection is essential to provide appropriate treatment. Additionally, ILAS patients require screening for endophthalmitis.

PMID:
42339155
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.