Retrospective Single Center Epidemiological Study Of Community Acquired Pyogenic Liver Abscess

Objective: To investigate the epidemiological characteristics of Community acquired pyogenic liver abscess(CA-PLA)in recent 7 years for its early identification,early diagnosis and rational antibacterial treatment.Methods:A retrospective single center study was carried out in The First Hospital of China Medical University during 2011 to 2017.Patients with CA-PLA hospitalized in were recruited.We summarize the case number admitted every year,describe its clinical profile,identify the leading pathogen and their antibiotic susceptibility,reveiw the antimicrobial therapy in the real world,source control and prognosis including morbidity and mortality.Results: A total of 1063 cases were included in the study,and analysis showed that:(1)patient number admitted increased annually;(2)patient percentage with underlying hepatobiliary disease decreased from 17.3% to 7.3% year by year;(3)There were 274 patients(25.7%)with extrahepatic infection,including 194 cases with pulmonary infection,21 cases with urinary tract infection,2 cases with central nervous system infection,4 cases with endophthalmitis,3 cases with splenic abscess and subphrenic abscess,1 case with vertebral osteomyelitis,1 case with myocarditis,2 cases with endocarditis,psoas abscess and 1 cases with skin and soft tissue infection,positive blood culture was found in 86 patients;(4)445 cases were microbiologically diagnosed,of which,367 isolates from pus and drainage fluid,86 from blood,4 from urine,6 from sputum,and 4 from bile.Klebsiella pneumoniae was found in 371 cases(82.5%),Escherichia coli in 21 cases,other gram negative bacilli in 5 cases,Streptococcus in 14 cases,Staphylococcus in 9 cases,Enterococcus in 12 cases,and polymicrobial infection in 13 cases.(5)Klebsiella pneumoniae was the leading bacteria accounting for 91.6% of patients without underlying hepatobiliary disease,in contrast to 18% in patients with underlying hepatobiliary disease;(6)Except for resistance to ampicillin,Klebsiella pneumoniae susceptibility rate was 96.5% to second and other advanced cephalosporin,the susceptibility to carbapenems more than 99% with only one imipenem intermediate isaote.(7)Most patients had good prognosis,of which 1049 cases were discharged for cure or improvement,6 cases left hospital voluntarily,and 8 cases died.Conclusion:1?The incidence of CA-PLA is increasing year by year;2?Majority of patients do not have underlying hepatobiliary disease;3?The cases with extrahepatic infection have increased year by year;4?The leading pathogens were Klebsiella pneumoniae,and clinically-defined hvKP infection increased year by year.