Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics

Background: Klebsiella pneumoniae liver abscess (KPLA) has been reported with increasing frequency in East Asian countries in the past 3 decades, especially in Taiwan and Korea. Diabetes is a well-known risk factor for KPLA and highly associated with septic metastatic complications from KPLA. We investigated the association of glycemic control in diabetic patients with the clinical characteristics of KPLA in Taiwan. Methods: Adult diabetic patients with KPLA were identified retrospectively in a medical center from January 2007 to January 2012. Clinical characteristics were compared among patients with different levels of current hemoglobin A1c (HbA(1c)). Risk factors for metastatic infection from KPLA were analyzed. Results: Patients with uncontrolled glycemia (HbA(1c) >= 7%) were significantly younger than those with controlled glycemia (HbA(1c) < 7%). Patients with uncontrolled glycemia had the trend to have a higher rate of gas-forming liver abscess, cryptogenic liver abscess, and metastatic infection than those with controlled glycemia. Cryptogenic liver abscess and metastatic infection were more common in the poor glycemic control group (HbA(1c) value > 10%) after adjustment with age. HbA(1c) level and abscess < 5 cm were independent risk factors for metastatic complications from KPLA. Conclusions: Glycemic control in diabetic patients played an essential role in the clinical characteristics of KPLA, especially in metastatic complications from KPLA.