| Objective: By analyzing the pathogenic characteristics,clinical manifestations,treatment and predisposing factors of patients with bacterial liver abscess(BLA),the level of diagnosis and treatment of BLA was further improved.Methods: The clinical data of 306 cases of BLA hospitalized in our hospital from January 2015 to December 2018 were analyzed retrospectively,including basic diseases,clinical manifestations,laboratory tests,imaging tests,etiology tests,treatment measures and outcomes.Results: A total of 306 BLA patients were collected,including 213 males and 93 females,with a male-to-female ratio of 2.29:1.The average age was 57.33±13.84 years,and the peak age was 50～69 years.The most common underlying diseases were diabetes(140 cases,45.75%),followed by biliary diseases(105 cases,34.31%).The most common clinical manifestations were fever(271 cases,88.56%),followed by chills and chills(177 cases,57.84%)and abdominal pain(118 cases,38.56%).The triple sign of typical fever,shivering and abdominal pain accounted for only 85 cases(27.78%).The positive rate of pus culture was higher than that of blood culture(65.18%vs 33.59%,P<0.001).Of these,Klebsiella pneumoniae accounted for 64.74%(123/190)and Escherichia coli accounted for 8.95%(17/190).The proportion of ESBLs producing bacteria was 4.88%(6/123)and 23.53%(4/17)respectively.The comparison was statistically significant(P<0.001).Of the 123 strains of Klebsiella pneumoniae,there were 101 strains of classic Klebsiella pneumoniae and 22 strains of Hypervirulent Klebsiella pneumonia.The ESBLs producing strains are 6 strains and 0 strains respectively,but there was no significant difference between the two groups(P=0.59).The resistance of Escherichia coli to aztreonam,ceftazidime,ciprofloxacin,cefepime,cefotaxime,levofloxacin,tetracycline,piperacillin,ampicillin sulbactam,compound sulfamide was higher than that of Klebsiella pneumoniae(all P<0.05).Nivariate and multivariate logistic regression analysis suggested that diabetes(OR=4.468,P<0.001),biliary stones(OR=0.374,P=0.019),and direct bilirubin(OR=0.971,P=0.032)were related to Klebsiella pneumoniae infection in BLA patients.Based on the above three factors,a regression model logit(P)was constructed.The model predicted that the area under the curve(AUC)of Klebsiella pneumoniae infection in BLA patients was 0.816(95% CI:0.760-0.864),and the sensitivity and specificity were 73.17% and 75.47%respectively.218 patients(71.24%)selected antibiotic percutaneous catheterization for drainage.The total effective rate of 306 patients was 90.45%,and the hospital mortality rate was 2.94%.The most common complications were respiratory tract infection(80cases,26.14%).Of 123 cases Klebsiella pneumoniae liver abscesses,20 cases(16.26%)had invasive syndrome.Conclusion: BLA occured in middle-aged and elderly people.It was more common in men and was often accompanied by diabetes.Fever was the most common clinical manifestation,and the typical triple sign was rare.Klebsiella pneumoniae was the main pathogen of BLA,while diabetes was an independent risk factor for Klebsiella pneumoniae infection.The resistance of Klebsiella pneumoniae was lower than that of Escherichia coli,and the resistance of Hypermucoviscous Klebsiella pneumonia might be less than that of classic Klebsiella pneumonia.On the basis of positive anti-infection combined percutaneous catheter drainage was the main treatment.The overall prognosis of BLA was good,combined with respiratory tract infection was more common.It was necessary to guard against the occurrence of invasive Klebsiella pneumoniae liver abscess syndrome. |
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