The Clinical Features,Diagnosis And Treatment Of 280 Cases Of Bacterial Liver Abscess

Objective The predisposing factors,clinical manifestations,pathogenic characteristics,treatment methods and efficacy of therapy in the patients with bacterial liver abscess were retrospectively analyzed,in order to improve the ability to diagnosis and treatment of bacterial liver abscess.Methods The clinical data of 280 cases of bacterial liver abscess treated in our hospital from March,2011 to August,2016 were analyzed retrospectively.Results 280 cases of patients with bacterial liver abscess,162 cases were male,118 were female,aged from 17 to 97(58.53±14.57)years old.Among them,there were 141 cases of elderly patients whose age 60 years or older,131 cases with diabetes mellitus,131 cases with liver and gallbladder pancreatic diseases.133 cases of liver abscess were found by type B ultrasound examination,144 cases by computer tomography(CT)examination.There were 62 cases to be found on the left lobar,182 cases on the right lobar,36 cases on two lobar of the liver.195 patients had asolitary abscess.The largest of the abscess cavity was 17.8cm × 13.6cm,the smallest of which was 1.3cm × 1.1cm.There were 215 cases of patients with fever,77 cases patients suffering from pain in the right upper party of abdomen,and 209 cases of patients with liver area tenderness,percussion pain,hepatomegaly.Bacteriological detection: there were 215 cases of blood culture,165 cases to be carried pus culture,the positive rates of bacteria culture were 18.88% and 46.67% respectively.Bacteriological distribution: 77 cases had bacteriological evidence,the main pathogen of bacteriology was Klebsiella pneumoniae,accounting for 64.94%,followed by Escherichia coli,accounting for 12.99%.280 patients with bacterial liver abscess were treated with antibiotic agents.There were 115 cases receiving simple antibiotic treatment,64 cases receiving percutaneous catheter drainage combined with antibiotic treatment,92 cases receiving surgical resection combined with antibiotic treatment,and 9 cases receiving percutaneous catheter drainage,surgical resection combined with antibiotic therapy.The main types of antibacterial agents applied in the treatment of the liver abscess including nitroimidazole,cephalosporin class antibacterial agents or combined with beta lactamase inhibitor,carbapenems,semi-synthetic penicillin class combined with beta lactamase inhibitor,quinolones antibiotic.Clinical outcome of 280 cases of liver abscess in this group,the clinical effective treatment rate was 96.11%(272 cases),7 cases were invalid,one was death.Conclusions This study showed that bacterial liver abscess often occurred in the elderly patients and these patients with diabetes mellitus,liver and gallbladder pancreatic diseases.The most common etiology of bacterial liver abscess was Klebsiella pneumonia.Abdominal ultrasonography and CT were mainly examination routines to detect hepatic abscess.The type B ultrasound examination with non-invasive,high accuracy,cost-effective features should be used as the first choice of examination method in screening and follow-up of liver abscess..Besides to active antibacterial treatment,combined with percutaneous catheter drainage or surgical resection were the most effective methods of treatment in the patients with bacterial liver abscess.