Outcomes after early versus delayed antibiotic treatment of liver abscess in Japan: A nationwide retrospective cohort study

Background: The optimal timing of antibiotic administration in patients with a liver abscess undergoing liver aspiration or drainage is unknown.Methods: This was a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database in Japan.
Results: A total of 34,424 patients who were emergently hospitalized due to liver abscess between July 2010 and March 2020 were included. Of these, 31,248 (90.8%) received antibiotics on the day of admission (early anti-biotics group), and 3176 (9.2%) did not (delayed antibiotics group). Multivariable logistic regression analyses showed that in-hospital mortality of patients in the early antibiotics group was significantly lower than that in the delayed antibiotics group (odds ratio, 0.61; 95% confidence interval, 0.52-0.72; p <0.001). Patients in the early antibiotics group had a significantly lower proportion of clinical deterioration (odds ratio, 0.73; 95% confidence interval, 0.63-0.84; p <0.001) and shorter length of stay (adjusted difference,-5.2 days; 95% confidence interval,-6.2 to-4.1 days; p <0.001) than those in the delayed antibiotics group.Conclusions: Starting antibiotic treatment on the day of admission was associated with lower mortality, a lower proportion of clinical deterioration, and a shorter length of hospital stay.