Background. During the past two decades, Klebsiella pneumoniae (K. pneumoniae) had surpassed Escherichia coli (E. coli) as the predominant isolate from patients with pyogenic liver abscess (PLA) in Asian countries, the United States, and Europe, and it tended to spread globally. Since the clinical symptom is atypical, the accurate and effective diagnosis and treatment of K. pneumoniae liver abscesses (KLAs) are very necessary. Methods. Here, we have comprehensively clarified the epidemiology and pathogenesis of KLA, put emphases on the clinical presentations especially the characteristic radiographic findings of KLA, and thoroughly elucidated the most effective antibiotic strategy of KLA. Results. K1 serotype is strongly associated with KLA especially in diabetic patients. Computed tomography (CT) and ultrasound (US) were two main diagnostic methods of KLA in the past. Most of KLAs have solitary, septal lobular abscesses in the right lobe of liver, and they are mainly monomicrobial. Broad-spectrum antibiotics combined with the US-guided percutaneous drainage of liver abscesses can increase their survival rates, but surgical intervention still has its irreplaceable position. Conclusion. The imaging features contribute to the early diagnosis, and the percutaneous intervention combined with an aminoglycoside plus either an extended-spectrum betalactam or a second- or third-generation cephalosporin is a timely and effective treatment of KLA. 1. Introduction Pyogenic liver abscess (PLA) is a life-threatening infectious disease. Before the 1980s, E. coli was the most common pathogen that caused PLA and was mostly polymicrobial. However, during the past two decades, highly virulent strains of K. pneumoniae had emerged as a predominant cause of PLA in Asian countries and areas [1–5], the United States [6–11], and Europe [12–14], especially Taiwan [2, 15–22], and it tended to spread globally [23–26]. Recent researches have shown, unlike other bacterial-induced PLAs (Non-KLAs) which are mostly associated with biliary tract disorders [19, 27–30], that K. pneumoniae liver abscesses (KLAs) are often cryptogenic [3, 6, 17, 27, 29–34]. Metastatic meningitis or endophthalmitis is often complicated with KLA 10%–45% [9, 16, 30, 35–38], and most of KLA patients had diabetes mellitus [1, 15, 16, 22, 27, 29, 30, 35, 38, 39]. KLA has the characteristic radiographic findings which are different from those of Non-KLA [1, 6, 22, 30, 34, 38, 40, 41]. Up to date, the combination of systemic antibiotics and percutaneous drainage has become the treatment of choice for the
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