| Objective: 1.This study is aim to investigate the clinical records, distribution of bacterial pathogens and antimicrobial susceptibility testing in patients with pyogenic liver abscess, and to provide the clinical treatment guidance. 2. To investigate the clinical characteristics and risk factors of acute kidney injury(AKI) in patients pyogenic with pyogenic liver abscess.Methods: 1. We evaluated 554 patients with pyogenic liver abscess admitted to Tianjin Third Center Hospital from October 2006 to September 2014. We reviewed the medical records of patients, laboratory data, imaging, pathogenic examination and antimicrobial susceptibility results. Patients with acute kidney injury proceeded further analysis and all patients were divided into AKI group and non-AKI group. The incidence, stages and outcomes of AKI were determined according to the KDIGO criteria. Multivariate logistic regression analyses were used to select independent risk factors associated with the occurence.Results:1. The age at presentation in 554 patients with pyogenic liver abscess ranged from 18 years to 90 years, with mean age of 57.9±13.6 years. There were more men(66.6%) than women(33.4%) and the average length of stay were 16.7 ± 11.0 days. The most common of concomitant underlying disease was diabetes mellitus, followed by hepatobiliary diseases. The most common clinical features were fever and chills. All patients underwent imaging(ultrasound, CT and MRI) examination, showing that solitary abscess in the right lobe was commonly seen. The bacterial in patients with pyogenic liver abscess were majored in Klebsiella pneumonia(68.9%). The cultured Gram-positive bacteria were mainly resistant to ampicillin and cefazolin and the sensitivity of remaining antibiotics were more than 66%, of which norfloxacin and ertapenem had the sensitivity of 100%. The cultured Gram-positive bacteria were mainly resistant to erythromycin and clindamycin, whereas sensitive to vancomycin, ceftriaxone, cefaclor, and cefotaxime(100%). All patients received antibiotic treatment, of which 152 cases(27.4%) patients using a variety of different types(?3) of antibiotics alternately. Non-drug treatment methods for the patients with pyogenic liver abscess was B ultrasound-guided percutaneous catheter drainage of pus, which was carried in 393 cases accounted for 70.9%. The most common complication was pleural effusion(36.6%), followed by pneumonia(13.0%) and AKI(12.3%).2. The incidence of AKI in patients with pyogenic liver abscess was 12.3%(68/554) according to KDIGO criteria and 37(54.4%) of whom in AKI stage 1, 14(20.6%) stage 2 and 17(25.0%) stage 3. AKI occurred more frequently in patients with old age(>65 years), hypertension, chronic kidney disease or septic shock(all P<0.05) and the mortality in patients with AKI was higher compared to those without(P<0.05). Patients with AKI had lower mean arterial pressure, hemoglobin and ALB levels, whereas AST, BUN and s Cr levels were higher than patients without AKI.Conclusion: 1. Pyogenic liver abscess occurred more frequently in males and older age. The abscess was commonly seen in right lobe. Diabetes and biliary diseases were the most important risk factors. The diagnosis of pyogenic liver abscess required a combination of diverse clinical manifestations, imaging, bacterial etiology and other laboratory examinations, if necessary, liver biopsy was adopted. The bacterial in patients with liver abscess were majored in Klebsiella pneumonia and susceptive to the majority of antibiotics. Percutaneous liver aspiration and catheter drainage combination with antibiotics were the main treatment of liver abscess. The most common complications of liver abscess were pleural effusion, pneumonia and acute kidney injury.2. Acute kidney injury is a common and severe complication in patients with liver abscess. Patients with greater age, and those with hypertension or septic shock and those of poor state of liver function had the worse prognosis. The higher level of serum creatinine, hypertension and septic shock were found to be independent risk factors of AKI occurrence in patients with liver abscess. In clinical practice, we should monitor the level of serum creatinine frequently for early identification of potential new episodes and progress of AKI. |
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