Clinical Analysis Of 16 Cases Of Diabetes Mellitus With Bacterial Multi-viscera Abscess

Objective: To summarize the clinical features and treatment experience of 16 cases of diabetes mellitus with bacterial multi-viscera abscess.Methods: Analyzed 1046 cases of the admitted patients with bacterial parenchymal viscus abscess in thoracic and abdominal cavity in the Second Hospital of Dalian Medical University from January 1991 to December 2015.274 cases were diabetic patients including 258 cases complicated with single viscus abscess and only16 cases with two viscera suffered.772 cases were non-diabetic patients with single viscus abscess.The clinical data of 16 cases of diabetes mellitus with bacterial multi-viscera abscess were retrospectively analyzed.Results:1.Diabetes mellitus with bacterial multi-viscera abscess accounted for 1.5%(16/1046)in the hospitalized patients with bacterial viscus abscess and for 5.8%(16/274)in diabetes mellitus complicated with viscus abscess.Liver abscess accounted for 55.7%(574/1030)in patients with one viscus abscess and for 68.2%(176/258)in those with diabetes mellitus.Diabetes mellitus with liver abscess was more prone to develop multi-viscera abscess.2.Among the 16 cases of diabetes mellitus complicated with bacterial multi-viscera abscess,male accounted for 81.2% of all.This disease occurred more frequently in group at 60 or older of age which accounted for 62.5% in all cases.Almost all of them were in poor control of blood sugar and the average of HbA1 c was(10.6±2.9)%.The majority had no specific history of infection,the percentage of which was 37.5% in my study.Irregular fever was the most common clinical symptom and theproportion of temperature at 39.0oC or higher was 93.7%.The average of maximum white blood cells was(15.25±6.83)x 109/L and that of neutrophils was(88.24±6.99)%.The positive rate of bacterial culture in pus was up to 100.0% and higher than that of other specimens.The infected rate of Klebsiella pneumonia was 81.2%.3.The common features of liver abscess included: the right lobe of liver(62.5%),single abscess(56.3%),5.00 ~ 10.00 cm in diameter(50.0%).The common features of renal abscess included: the right kidney(80.0%),single abscess(80.0%).The common features of lung abscess included: the bilateral lung(63.6%),multiple abscesses(81.8%).4.All patients were treated by antibiotics.The study showed that the third or second cephalosporin or quinolones was selected frequently and combined with nitroimidazoles or antifungal drug to get effective results.Percutaneous abscess drainage by ultrasonography or CT guided was performed in 8 cases(50.0%)and the ultrasonography-guided drainage was the most common mean.5.14 patients were improved and 2 cases discharged from hospital.The total effective rate was 87.5%.Conclusions:1.Diabetes mellitus with bacterial multi-viscera abscess is not uncommon.Diabetic patients more frequently complicate with liver abscess,which are more prone to develop multi-viscera abscess that condition is serious.2.The gerontism male group with higher fire and increased white blood cells should be guarded the occurrence of viscus abscess.Diabetic group with the same conditions should be paid attention to the development of multi-viscera abscess.3.The most common pathogenic bacteria is Klebsiella pneumonia in diabetes mellitus with multi-viscera abscess.Appropriate therapeutic strategies include effective antibiotics selected early and reasonably,timely drainage of abscess by ultrasonography or CT guided.