Disentangling the Causal Role of Gut Microbiota in Bacterial Liver Abscess: A Mendelian Randomization Study with Clinical Validation.

Bacterial liver abscess (BLA), accounting for approximately 80% of all liver abscesses, is a severe suppurative infection of the liver. Although gut microbiota dysbiosis has been implicated in BLA pathogenesis, causal evidence remains limited. Here, we integrate Mendelian randomization (MR) and clinical cohort studies to systematically evaluate the causal role of gut microbiota in BLA. Using summary-level genetic data from MiBioGen, GWAS Catalog, and the Pan-UK Biobank, we identified several causal microbial taxa: Coprococcus, Veillonellaceae (including Dialister), and Klebsiella were positively associated with BLA risk, whereas Bacteroides and Bifidobacterium appeared protective. Clinical validation confirmed significant enrichment of Veillonella, Dialister, and Streptococcus in the gut and oral microbiota of BLA patients, contrasting with the predominance of Bacteroides and Bifidobacterium in healthy controls. Klebsiella was the most abundant genus in abscess pus, and gut microbial metabolic profiling revealed marked upregulation of glycolytic pathways in BLA patients. These results indicate that gut dysbiosis exacerbates BLA development through microenvironmental disruption and metabolic reprogramming. Our findings provide mechanistic insights into BLA etiology and suggest microbiota-targeted interventions as promising strategies for prevention and treatment.