Etiology Of Bacterial Liver Abscess And The Ratio Of Neutrophil To Lymphocyte For Prognosis

Background:Bacterial liver abscess is a potentially life-threatening disease,which affects many parts of the world,especially Asian countries,with incidence rates ranging from 1.1 to17.6/100,000^[1].There are reports that the death rate of bacterial liver abscess can be as high as 80%if it cannot be treated in an early standard and reasonable manner^[2].Unfortunately,there is no report on the etiology of bacterial liver abscess in local areas,and there is no effective marker for prognosis of bacterial liver abscess at present.However,neutrophil-to-lymphocyte ratio?NLR?is more and more widely used as a prognostic marker for various diseases^[3-4],but NLR has few reports on prognosis of bacterial liver abscess,which still needs further discussion.Objective:To collect the information of patients with clinical liver abscess and analyze the main clinical features,bacterial strain distribution and bacterial drug sensitivity test results of bacterial liver abscess cases.To explore the prognostic value of NLR for bacterial liver abscess,so as to provide help for the patients with bacterial liver abscess to formulate reasonable treatment plan.Methods:263 patients with bacterial liver abscess who met the inclusion criteria^[5]from June 2015 to November 2018 in Second Hospital of Dalian Medical University were selected as the research objects.The main clinical characteristics of the patients,the distribution of bacterial culture strains,the results of drug sensitivity experiments and the differences of laboratory examination results were analyzed.According to the department and clinical prognosis of patients with bacterial liver abscess,they were divided into general ward group,intensive care ward group,death group and survival group.NLR of each group was calculated and its prognosis was analyzed.SPSS25.0software was used for statistical analysis of all data.Results:Of 263 patients with bacterial liver abscess,166 were male?63.12%?and 97 were female?36.88%?,with a male/female ratio of 1.71?1.Compared with the basic diseases of bacterial liver abscess,106 cases?70.67%?of Klebsiella pneumoniae liver abscess were accompanied by diabetes?p<0.05?,while19 cases?65.52%?of non-Klebsiella pneumoniae liver abscess were accompanied by biliary tract diseases?p<0.05?.In 263 patients with bacterial liver abscess,a total of 218 strains of 11 kinds of bacteria were obtained from bacterial culture,208 strains of Gram-negative bacilli,176strains of Klebsiella pneumoniae?80.73%?were the absolute dominant,followed by19 strains of Escherichia coli?8.72%?.There were 10 gram-positive bacteria,including2 strains of streptococcus intermedius,2 strains of streptococcus viridans,2 strains of staphylococcus epidermidis,2 strains of staphylococcus hominis and 2 strains of listeria monocytogenes?0.92%?.Among them 227 cases were punctured for pus culture,181cases?79.74%?were positive for pus culture.183 strains of bacteria,152 strains of Klebsiella pneumoniae?83.06%?and 13 strains of Escherichia coli?7.10%?were obtained.111 cases underwent blood culture,35 cases?31.53%?were positive in blood culture,35 strains of bacteria were obtained,24 strains of Klebsiella pneumoniae?68.57%?and 6 strains of Escherichia coli?17.14%?.The drug sensitivity test results of Klebsiella pneumoniae showed that the sensitivity to?-lactam antibiotics,fluoroquinolones,aminoglycosides,sulfonamides and tetracyclines was more than 85%.The drug sensitivity test results of 19 strains of Escherichia coli showed that 15 strains?78.95%?were ESBLs-producing Escherichia coli.The drug resistance rate of?-lactam antibiotics?ampicillin,piperacillin,ceftriaxone,cefazolin,cefuroxime?and fluoroquinolones?levofloxacin,ciprofloxacin?was more than 90%.The sensitivity rate to cefepime,ceftazidime and aztreonam is about 30%,the sensitivity rate to cefotetan and piperacillin-tazobactam compound preparation of enzyme inhibitor is higher than 85%,and the sensitivity rate to carbapenems?meropenem and imipenem?is 100%.263 patients with bacterial liver abscess,129 patients were included in the analysis of prognostic factors.Multivariate binary logistic regression analysis showed that NLR?OR=1.053,95%CI:1.012-1.096,P=0.011?was the only risk factor for predicting the admission of patients to intensive care unit.The area under ROC curve?AUC?was 84.9%?95%CI:0.774-0.924?,and the optimal critical value was 12.25.NLR?OR=1.070,95%CI:1.003-1.142,P=0.041?is also the only risk factor for predicting patient death.The area under ROC curve?AUC?is 91.6%?95%CI=0.863-0.969?,and the optimal critical value is 25.19.Conclusion:The majority of patients with bacterial liver abscess are men.Most of Klebsiella pneumoniae liver abscesses are accompanied by diabetes mellitus,while most of non-Klebsiella pneumoniae liver abscesses are accompanied by biliary tract diseases.The main pathogen of bacterial liver abscess is Klebsiella pneumoniae,followed by Escherichia coli.The drug sensitivity test results of Klebsiella pneumoniae showed that it was sensitive to common antibiotics.Cefotetan and carbapenem antibiotics should be the first choice for the treatment of escherichia coli producing?ESBLs?.NLR is positively correlated with poor prognosis of bacterial liver abscess.High level NLR can predict patients with bacterial liver abscess to be admitted to intensive care,with poor prognosis and high mortality.