Associations between antibiotics, proton pump inhibitors, NSAIDs and liver abscess

Abstract

Objective: Liver abscess (LA) caused by Klebsiella pneumoniae is endemic in Taiwan. This study aimed to clarify the associations between antibiotics, PPIs, and NSAIDs among patients hospitalized due to LA. Methods: This population-based, case-control study was conducted using the 2005 Longitudinal Generation Tracking Database of Taiwan's National Health Insurance, comprising 2 million insured individuals from 2000 to 2021. Individuals without LA were matched to adult LA patients by age and sex using propensity score matching (PSM). Exposure to antibiotics, PPIs, and NSAIDs within one year prior to diagnosis was assessed. Logistic regression analysis was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs). Results: After PSM, the data of 10,335 patients with liver abscess and 20,670 controls were analyzed. Within 7 days prior to hospitalization, univariate analysis showed significantly higher ORs of LA associated with 2nd/3rd generation cephalosporins (OR 181.91, 95 % CI 58.5-566.1), 1st generation cephalosporins (OR 18.5, 95 % CI 9.6-35.5), NSAIDs (OR 17.0, 95 % CI 11.7-24.8), amoxicillin/ampicillin with beta-lactamase inhibitors (OR 15.0, 95 % CI 7.5-30.0), PPIs (OR 9.5, 95 % CI 6.4-14.0), and fluoroquinolones (OR 9.2, 95 % CI 5.6-15.1). Multivariable logistic regression revealed that associations between LA and medication use persisted for NSAIDs, 2nd/3rd generation cephalosporins, and amoxicillin/ampicillin with beta-lactamase inhibitors up to one year prior to hospitalization. Conclusion: PPIs, NSAIDs, and some antibiotics are significantly associated with increased risk of LA, necessitating cautious medication use. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/li-censes/by-nc-nd/4.0/).