| ObjectiveThe clinical features,distribution of pathogens and drug sensitivity of 717 patients with bacterial liver abscess were retrospectively analyzed,in order to improve the level of clinical diagnosis and treatment.At the same time,the clinical difference between klebsiella pneumoniae and non-klebsiella pneumoniae was compared,so as to provide a reference basis for early diagnosis and early treatment of clinicians to reduce the occurrence of serious complications.Methods1.The study subjects: 717 patients with bacterial liver abscess who were admitted to Bethune first clinical college of jilin university Form January 2013 to January 2017;At the same time we screened 426 patients of positive etiology,and divide them into KPLA group(303 cases of klebsiella pneumoniae liver abscess)and NKPLA group(109 cases of non-klebsiella pneumoniae liver abscess)according to different pathogens,14 patients with klebsiella pneumoniae combined with other strains were excluded.2.Research methods:The clinical characteristics,the distribution of etiology and drug sensitivity were analyzed.;At the same time,compare the clinical differences between two groups in general information,symptoms,laboratory examination,lesion characteristics and treatment,complications..3.Statistical analysis:SPSS19.0 software was adopted.The measurement data of the normal or approximate normal distribution were expressed by means of mean plus and minus standard deviation(X ± S),and the comparison between groups was adopted with t-test.The metering data of the non-normal distribution was expressed in the median and quartile p25-p75 range,namely M(p25-p75),and the mann-whitney test was used for comparison between groups.Comparison of counting data was performed by Chi aquare or continutity correction test,and P<0.05 was considered statistically significant.Results1.Clinical features:717 patients,aged 3-98 years,included there are 474 males and 244 females;Among them,41-60 years(323 cases,45.05%)and 61-80 years(296 cases,41.28%).Main accompanied diseases included diabetes mellitus(297 cases,41.4%),biliary disease(232 cases,32.4%)and Abdominal surgery history(118 cases,16.5 %).Main performance were included fever(647cases,90.2%),chills(322cases,44.9%)and abdominal pain(275cases,38.4%).Liver lesion characteristics included single lesion(498 cases,64.5%)and right lobe(463 cases,64.5%).2.Distribution of pathogens:Among 717 patients,513 strains were detected,included 105 strains in peripheral blood and 408 strains in pus.there are Klebsiella pneumoniae(370 strains,72.12%),included 71 strains in peripheralblood(67.6%)and 299 strains in pus(73.3%);Klebsiella oxytoca(48 strains,9.36%)and escherichia coli(33 strains,6.43%)In the last four years,patients with bacterial liver abscess in our hospital were mainly klebsiella pneumoniae,and showed a rising trend of 65.88%,71.03%,71.84% and 76.87% respectively.However,the proportions of escherichia coli and klebsiella acidis were as follows: 10.59%,6.54%,8.62%,1.36% and 5.88%,9.35%,9.19% and 11.56% respectively.3.Drug susceptibility:In last four years the drug susceptibility of pneumonia klebsiella bacillus shows: higher sensitivity(> 90%)as for carbon penicillium alkene(Imipenem and meropenem),amikacin,cefotetan;high sensitivity(80-90%)as for cephalosporins,?-lactamase inhibitor and enzyme inhibitor antibiotics(cefoxitin,cefepime,cephalosporins he organism,ammonia QuNa,piperacillin and Tanzania,cefoperazone shu ba temple),the fluoroquinolone(levofloxacin,ciprofloxacin,aminoglycoside(gentamycin);absolute resistance to ampicillin.In the last four years,klebsiella pneumoniae has a drug resistance rate of 0,0,1.1 and 1.3 percent,which is 0,0,0.6% and 1.3%.Four years,a total of 48 strains klebsiella acids bacteria were developed,the drug susceptibility of them shows: higher sensitivity(> 90%)as for carbon penicillium alkene(Imipenem and meropenem),amikacin,cefepime;low sensitivity(> 90%)as for cefoxitin,ceftidine and levofloxacin.4.Comparison between two groups: the KPLA group with the diabetic patients were more than the NKPLA group,On the contrary the patients with the history of abdominal surgery and gallbladder disease(P<0.05).The incidence of abdominal pain in KPLA group was lower than that in the NKPLA group(P<0.05).The hemoglobin in the KPLA group was higher than the NKPLA group(P<0.05).The KPLA group had more than NKPLA group(P<0.05)in the abscess diameter of 5-10 cm and the separation formation.The incidence of sepsis in KPLA group was higher than that in the NKPLA group(P<0.05).The number of hospitalized days in the KPLA group was shorter than that of NKPLA(P<0.05).Conclusion1 The incidence of bacterial liver abscess was 41-80 years old,the majority of patients were male,male to female ratio 1.9:1,diabetes mellitus and biliary disease main accompanied diseases,fever,chills and abdominal pain are main symptoms,the right liver lobe single-shot is given priority to;2.Bacterial liver abscess is mainly caused by klebsiella pneumoniae.Klebsiella pneumoniae was dominant in the last four years and was increasing year by year.After 2014,the bacillus acidophilus has been passed the escherichia coli and rose to the second place.3.Klebsiella pneumoniae is sensitive to carbapenems,amikacin,cefepime,cefoperazone/shubatan,piperacillin/tazobartan,etc.The resistant rate of klebsiella pneumoniae to hydrocarbons was increased.4.Klebsiella acid-producing bacteria are sensitive to carbapenems,amikacin,compound antibiotics with enzyme inhibitor and fourth-generation cephalospora,and are not sensitive to other substances.5.KPLA is associated with diabetic basic diseases,low incidence of abdominal pain,mild anemia,and 5-10 cm in diameter of the lesion,which is always separated,prone to complications of sepsis,and short length of hospitalization. |
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