Clinical Outcomes of Ceftriaxone-Based De-escalation Therapy for Invasive Klebsiella pneumoniae Liver Abscess

Background The incidence of invasive Klebsiella pneumoniae liver abscess (IKLA), particularly caused by hypervirulent Klebsiella Pneumoniae (hvKP), has been rising, especially in East Asia. These strains, often linked to comorbidities such as diabetes, exhibit high virulence and a propensity for severe infections, including liver abscesses and metastatic complications. The emergence of carbapenem-resistant hvKP (CR-hvKP) further complicates treatment, highlighting concerns regarding antibiotic resistance. This study aimed to evaluate the efficacy and safety of step-down therapy in the management of hvKP-induced liver abscesses. Methods A total of 156 hospitalized patients diagnosed with Klebsiella pneumoniae liver abscess were included in the analysis. Participants were divided into two groups: a step-down therapy group (n = 69), where treatment was transitioned from broad-spectrum antibiotics to ceftriaxone, and a non-step-down group (n = 87), which continued broad-spectrum antibiotic therapy. Clinical outcomes, including liver abscess progression and treatment-related adverse effects, were compared between the two groups. Results Both groups demonstrated comparable reductions in abscess size, and no significant differences in safety profiles were observed. Importantly, no adverse events were attributed to step-down therapy. The treatment success rate was 100% in the step-down group, compared to 90.8% in the non-step-down group, a difference that was statistically significant (P = 0.01). These results indicate that step-down therapy with ceftriaxone is an effective and safe approach for treating hvKP-induced liver abscesses. Conclusions Step-down therapy using ceftriaxone represents a viable, effective, and safe treatment option for hvKP-induced liver abscesses. It offers the advantage of reducing overall antibiotic use without compromising therapeutic efficacy. This study supports the rational implementation of step-down therapy in selected KLA patients and emphasizes the need for further prospective research to validate these findings across diverse clinical settings.