Background: Pyogenic liver abscess (PLA) remains a significant cause of morbidity worldwide, with recurrence posing considerable therapeutic and financial burdens on healthcare systems [1]. Despite advances in imaging modalities and minimally invasive interventions, many patients experience repeated episodes, often associated with certain predisposing factors and demographic variables [2]. This study aimed to evaluate clinical profiles, risk factors, and management modalities impacting recurrence of PLA in a tertiary care setting. Methods: A prospective observational study was conducted on 100 patients with confirmed PLA over a 12-month period. Demographic data, clinical histories, and risk factors such as alcohol use, diabetes, smoking, and tuberculosis were documented. All patients underwent either aspiration with or without antibiotics, pigtail drainage, or surgical drainage (incision and drainage). Recurrence of abscess was defined as radiological or clinical reappearance within six months post-treatment. Data were analyzed using descriptive statistics and chi-square testing to identify factors associated with recurrence. Results: Overall, 25% of patients experienced recurrence. Solitary abscesses had a lower recurrence rate (16.7%) compared to multiple abscesses (37.5%). Bilateral involvement was linked with higher recurrence (50%) than right-sided (20%) or left-sided lesions (16.7%). Male patients exhibited a slightly higher recurrence rate (28.6%) than females (16.7%). Alcohol consumption and underlying comorbidities, notably diabetes (35% recurrence), were strongly associated with repeat abscess formation. Of the management modalities, aspiration combined with antibiotics had the lowest recurrence (12%), while pigtail drainage (30%) and surgical drainage (33.3%) had comparatively higher recurrence rates. Conclusion: PLA recurrence is multifactorial, influenced by host factors (comorbidities, dietary habits) and lesion characteristics (laterality, multiplicity). Optimizing treatment strategies, especially aspiration with appropriate antibiotic coverage, could reduce recurrence rates. Adequate management of comorbidities and lifestyle factors may further mitigate risk.