Analysis Of Clinical Characteristics And Drug Resistance Of Pyogenic Liver Abscess

Objective:Through the analysis of the clinical characteristics,pathogen distribution and drug resistance of Pyogenic liver abscess,it provides a theoretical basis for the diagnosis and treatment of Pyogenic liver abscess,thereby improving the diagnosis rate and cure rate of Pyogenic liver abscess,and providing assistance for improving the level of diagnosis and treatment.Methods:Basic conditions,etiology,pathogens,underlying diseases,clinical features,laboratory and imaging examinations,clinical diagnosis of 224hospitalized patients with a diagnosis of Pyogenic liver abscess in the First Hospital of Jilin University from December 2015 to December 2018The selection of treatment methods and the susceptibility results of pathogenic bacteria were retrospectively analyzed.Results:Of the 224 patients with Pyogenic liver abscess,129 were male(58%),95 were female(42%),and the number of male patients was more than female.Male:female=1.4:1,mean age 63 years,with underlying disease with diabetes 97 For example,93 cases of biliary diseases(cholecystitis,gallstones),31 cases of gallbladder surgery,34 cases of liver disease,48 cases of hypertension,18 cases of coronary heart disease,20 cases of malignant tumors,62 cases of renal cysts,166 cases of pneumonia,There were 199 cases of fever in the clinical manifestations,110 cases of chills and chills,43 cases of anorexia,49 cases of peripheral weakness,10 cases of nausea and vomiting,40 cases of abdominal distension,12 cases of diarrhea,20 cases of dizziness and headache,68cases of cough and expectoration.Unclear 11 cases,96 cases of abdominal pain,20 cases of pain in the liver area.Laboratory examination:white blood cell(WBC)increased by>9.5×10~9/L in 147cases,neutrophil percentage(NE%)increased by>0.75 in 193 cases,and platelet(PLT)decreased in<125×10~9/L in 52 cases.Prothrombin time(PT)was prolonged by>13S in 109 cases,C-reactive protein(CRP)was increased by>8 mg/L in 137 cases,procalcitonin(PCT)was increased by>0.5ug/L in 84 cases,and anemia was<120g/L 26 cases,transaminase ALT increased>50U/L 114 cases,AST increased>40U/L 123 cases,glutamyl transpeptidase(GGT)increased>60U/L 183cases,alkaline phosphatase(ALP)142 cases were increased by>125 U/L,112 cases of albumin(ALB)<30g/L,58 cases of total bilirubin(TBIL)increased by>30umol/L,creatinine(Cr)increased by>497umol/L and kidney 23 cases of insufficiency.Imaging examination(ultrasound or CT examination):151 cases(67%)with single liver hepatic abscess,40 cases(18%)with single liver hepatic lobe abscess,8 cases(4%)with caudate lobe,left and right liver There were 25 cases(11%)in the leaves,161cases in single cases and 61 cases in multiple cases.Among 224 patients with Pyogenic liver abscess,184 patients were positive for blood or(and)pus culture,of which 136 were positive for pus culture,18 were positive for blood culture,and 30 were positive for pus culture and blood culture.A total of 14 species and 215 strains of bacteria were cultured in pus and blood samples.Among them,158 strains of Klebsiella pneumoniae,12strains of Escherichia coli,14 strains of Streptococcus,14 strains of Enterococcus,and Kreiber There are 5 strains of Bacillus,3 strains of Enterobacter cloacae and Acinetobacter baumannii,2 strains of Enterobacter aerogenes,Clostridium perfringens and Candida albicans.Klebsiella pneumoniae is the main drug,Klebsiella pneumoniae is fully resistant to ampicillin,and the sensitivity to quinolones,aminoglycosides,β-lactams,carbapenems can reach more than 90%.In the treatment,53patients were treated with antibiotics alone,24 patients underwent percutaneous puncture and puncture,159 patients underwent puncture drainage,15 patients underwent laparoscopic surgery,3 patients underwent hepatectomy,and 2 patients underwent open surgery.No treatment was combined with antibiotics.Results:210 cases(93.8%)improved,13 cases(5.8%)did not heal,and 1 case(0.4%)died.Conclusion:1.Pyogenic liver abscess patients mostly male,the average age of 63years old,with a single right liver lobe abscess is the most common,diabetes,biliary tract disease is a common underlying disease.2.PLA clinical manifestations are diverse,the most common is fever,high body temperature,often accompanied by chills,chills,abdominal pain symptoms are not typical.Most patients have elevated white blood cells,neutrophils,C-reactive protein,γ-glutamyl transpeptidase,and alkaline phosphatase.3.The pus culture has a higher positive rate than the blood culture.The most common pathogen is Klebsiella pneumoniae.Klebsiella pneumoniae has higher resistance rate to ampicillin and recurrent sulfamethoxazole,and to other quinolones.The sensitivity of aminoglycosides,β-lactams,and carbapenems can reach more than 90%.4.The most commonly used treatments are intravenous antibiotics+percutaneous transhepatic drainage.