Clinical And Etiological Characteristics Analysis Of Patients With Pyogenic Liver Abscess

BackgroundPyogenic liver abscess is a type of infectious disease in which bacteria invade the liver through the blood,biliary system or adjacent organs,causing purulent necrosis of liver.The distribution of pathogenic bacteria of PLA tends to be diversified and the clinical manifestations are gradually atypical,leading to difficulties in the diagnosis and poor efficacy of PLA,which brings a heavy economic burden of disease to patients and society.In order to optimize the treatment of PLA and improve the therapeutic effect,a comprehensive and in-depth study of its clinical characteristics and pathogenic features is of great clinical significance.ObjectiveIn this study,we retrospectively studied the clinical data of PLA patients of Xiangya Hospital of Central South University in the past 10 years,analyzed their clinical characteristics and pathogenic features,and provided a reference basis for clinical diagnosis and treatment.The patients with positive bacterial cultures were selected for group comparison to investigate the risk factors of multi-drug resistance(MDR)PLA to reduce the rate of MDR bacterial infection.MethodsPatients with PLA who were hospitalized in Xiangya Hospital of Central South University from January 2010 to December 2019 were selected to analyze their clinical characteristics such as demographic characteristics,underlying diseases,clinical manifestations,laboratory tests,imaging examinations,etiology,drug sensitivity tests and treatments.PrognosisPatients with positive pathogenic culture were screened and divided into MDR-PLA group and non-MDR-PLA group.The clinical characteristics,pathogenic distribution,and drug resistance of the two groups were contrasted.Logistic regression analysis was applied to screen the risk factors of MDR-PLA.Results(1)Demographic data: A total of 495 patients were enrolled,of whom305(61.62%)were male,190(38.38%)were female;7(1.41%)were younger than 20 years old,65(13.13%)were at the age of 41-60,271(54.75%)were at the age of 41-60,152(30.71%)were older than 60 years old.166 cases(33.54%)were with gallstone,140 cases(28.28%)were with type 2 diabetes,98 cases(19.8%)were combined with a hepatobiliary surgery history.349 cases(70.51%)with fever,279 cases(56.36%)were with chills,and 258 cases(52.12%)were with abdominal pain.(2)Therapeutic methods: All patients were treated with antimicrobials,and 208 cases(42.02%)underwent antimicrobials combined with percutaneous drainage,156 cases(31.52%)were with antimicrobials alone,103 cases(20.81%)were with antimicrobials combined with surgery,and11 patients(2.33%)cases were with antimicrobials combined surgery and percutaneous drainage.During treatment,216 cases(43.64%)developed pleural effusion,17 cases(3.43%)developed septic shock,metastatic abscesses was seen in 15 patients(3.03%).(3)Etiological features: A total of 180 strains of bacteria were detected in the 495 patients,and the three most common types of bacteria were Klebsiella pneumoniae(107 strains,59.44%),Escherichia coli(22strains,12.22%),and Enterococcus(15 strains,8.33%);MDR bacteria accounted for 86.67% in Enterococcus Bacteria,77.27% in Escherichia coli and 25.23% in Klebsiella pneumoniae.(4)Comparisons between groups: Worse appetite,abdominal pain,gallstones and hepatobiliary surgical history were more common in MDRPLA group.Liver dysfunction(TBIL>34.2μmol/L)was more common in the MDR-PLA group(P<0.05).Logistics regression results suggest that biliary stones and hepatobiliary system surgical history were the two major risk factors for MDR-PLA.Conclusion(1)Patients with PLA were predominantly middle-aged and elderly men with underlying diseases such as gallstone and type 2 Diabetes,and they may present with a variety of clinical symptoms and signs.The most common therapy option was antibiotics combined with percutaneous drainage,and the most common complication during treatment was pleural effusion.(2)The three most common pathogens in PLA were Klebsiella pneumoniae Escherichia coli and Enterococcus faecalis in that order,with the highest proportion of MDR bacteria being Enterococcus faecalis.(3)Gallstone and hepatobiliary surgery history were the two major risk factors for MDR bacterial-associated PLA.