Study Of Klebsiella Pneumoniae Liver Abscess In The Early Diagnosis And Treatment

【Background】Liver abscess is a common form of intraabdominal infection with bacterial and so on.Before the 1970s,treatment with surgical drainage is the main therapeutic method,which often cause high incidence rate of surgical complications and mortality.As clinics and technological progress, percutaneous liver puncture and broad-spectrum antibiotic were widespread used.The prognosis of patients has been greatly improved,and the fatality rate decreased from 70%to about 16%.Before the 1980s,Escherichia coli was the most common cause of pyogenic liver abscess,but more recently, Klebsiella pneumonia has emerged as the most common organism in the world.【Objective】The aim of this reseach is to analyze the differences between pyogenic liver abscess caused by Klebsiella pneumonia and non- Klebsiella pneumoniae, and to provide the evidence for early diagnosis and treatment.【Methods】From March 2001 to January 2009,there were 197 patients with pyogenic liver abscess of Zhongshan hospital were included in the study to be retrospectively reviewed.Abscess clinical,laboratory,and microbiologic characteristics and treatment and outcome were analyzed.US and CT images were classified.Clinical and image characteristics of patients with K pneumoniae liver abscesses(KLA) and those with non-K pneumoniae liver abscesses(NKLA) were compared.Statistical analyses were performed with a software package(SPSS 16.0).The x~2 exact test was used for categorical variables,and t test was used for continuous variables.P＜0.05 was regarded as indicating a statistically significant difference.【Results】197 cases were collected.106(53.8%)cases of monomicrobial KLA were classified into KLA group,and 56(28.4%) cases of monomicrobial NKLA were classified into NKLA group.There were significant differences between the KLA group and NKLA group in underlying diseases,including diabetes(53.8%vs 25.0%,P＜0.001),abdomen operation(17.0%vs 35.4%, P＜0.001),hepatic adipose infiltration(16.0%vs 5.4%,P＜0.05),carcinoma(2.8%vs 12.5%,P＜0.05),chemotherapy and radiotherapy(1.9%vs 10.7%,P＜0.05).For clinical manifestations and laboratory features,there were also significant differences in abdominal pain(48.6%vs 57.1%,P＜0.05), hypodynamia(19.8%vs 46.4%,P＜0.001),hepatomegaly(4.7%vs 14.3%, P＜0.05),and blood-glucose(7.84±0.36 vs 5.76±0.30,P＜0.001) between two groups.KLA is often appearanced in the right robe,alone.The results of CT show that gas formation make significant difference between two groups(32.9%vs 13.5%,P＜0.001).Smooth and regular rim was more common in NKLA group(71.2%vs 40.5%,P＜0.001).On the dynamic CT,there was significant difference of septum strengthen(41.1%vs 16.2%,P＜0.05) between two groups.For the treatment of KLA group,drainage with indwelling catheter after percutaneous liver puncture maked more reduce size of abscess(34.38±3.25 vs 22.67±2.37,P＜0.05).【Conclution】In comparison with those in NKLA patients,the rate of diabetesand and hepatic adipose infiltration are higher,the clinic significant is markedness. KLA is often appearanced in the right robe,alone,with blur rim and gas formation.On the dynamic CT,there was significant difference of septum strengthen.Drainage with indwelling catheter may be the more effective therapy.