Analysis On Clinical Characteristics Of Bacterial Liver Abscess

Background:Bacterial liver abscess(BLA)is a clinical and common infectious disease,and it has been increased for decades.Due to the extensive use of antibiotics in clinical practice,the pathogenic characteristics and resistance to antimicrobial agents of BLA have changed.At present,Klebsiella pneumoniae is the main pathogen of BLA in China,and gram-positive bacteria?fungi can be seen in other patients.Liver abscess caused by Klebsiella pneumoniae is called Klebsiella pneumoniae liver abscess(KPLA).Compared with non-KPLA,KPLA has different clinical characteristics and should be distinguished.KPLA is prone to extrahepatic metastatic infection,including intracranial infection,endophthalmitis and abscess formation in other parts.The most common extrahepatic metastatic infection is endophthalmitis,which seriously affects the patient's vision.The extrahepatic metastatic infection known as invasive syndrome has been attention at home and abroad.At present,there are few reports of BLA in Shandong Province.Objective:By analyzing the clinical characteristics and drug sensitivity results of BLA patients,we can instruct doctors to use antibiotics properly and control the disease progression and improve the prognosis of patientsMethod:We collected the clinical date of patients who are diagnosed with BLA in Shandong University Qilu Hospital from January 2011 to January 2018.Results:1.Clinical distribution:Among 218 patients diagnosed with BLA,male(72.0%)was more than female(28.0%).The basic diseases included biliary diseases(cholelithiasis,cholecystitis,cholestasis)(62.8%),diabetes(43.1%).The most common clinical manifestations were fever(94.0%)and chills(63.8%).Gastrointestinal symptoms such as abdominal pain,nausea and vomiting accounted for a relatively small proportion of BLA.2.A total of 243 strains were cultured,including 210 strains(86.4%)of gram negative:132 strains(54.3%)of Klebsiella pneumoniae and 57 strains(23.4%)of Escherichia coli;30 gram-positive strains(12.3%);3 fungal strains(1.2%).3.Resistance to antimicrobial agents:Among 132 strains of Klebsiella pneumoniae,10(7.6%)were strains producing extended-spectrum lactamases(ESBLs).Among the 57 escherichia coli strains,33(57.9%)were ESBLs-positive and 1(1.8%)was carbapene-resistant.Klebsiella pneumoniae are sensitive of cephalosporins,quinolones,aminoglycosides and carbapenems.Escherichia coli has high drug resistance to cephalosporins,quinolones and compound neostigmine,and high sensitivity rate to carbapenems antibiotics.Among the 30 gram-positive strains,the sensitivity rate of tegacycline,vancomycin and datotocin was up to 100%.4.Imaging features:Single abscess was common in BLA,and mainly located in the right lobe of the liver,with a diameter of 5?10cm.5.Complications:The common complications included pleural effusion(53.2%),pulmonary infection(50.9%),and extrahepatic metastatic infection(9.6%).6.Treatment and efficacy:207 patients(95.0%)were discharged after improvement,and 8 patients(3.7%)were discharged automatically due to poor treatment effect,and 3 patients(1.4%)died.7.Compared with patients in the KPLA group,the female patient ratio of Escherichia coli liver abscess(ECLA)was higher than that in the KPLA group(P<0.05),and the mean age was greater than that in the KPLA group(P<0.05).The ECLA group was likely to be associated with biliary diseases(P<0.05),malignant tumors(P<0.05),and abdominal surgery(P<0.05).The ECLA group was likely to have abdominal pain(P<0.05)and knocking pain in the liver area(P<0.05).Blood platelet(PLT)and hemoglobin(HGB)in the ECLA group were lower than those in the KPLA group,and total bilirubin(TBIL)were higher than that in the KPLA group(P<0.05).In terms of complications,the ECLA group was likely to have pericardial effusion(P<0.05)and peritoneal effusion(P<0.05).KPLA group was likely to have diabetes mellitus(P<0.05),and the differences were statistically significant.There was no significant difference in therapeutic effect between KPLA group and ECLA group(P>0.05).8.There were 21 patients with KPLA who developed invasive syndrome.Among them,10 cases(47.6%)were complicated with endophthalmitis,and 8 cases(3 8.1%)were complicated with pulmonary abscess.9.The invasive syndrome group was likely to be associated with diabetes mellitus and rheumatic diseases(P<0.05).PLT and ALB in the invasive syndrome group were lower than those in the non-invasive syndrome group(P<0.05),and TBIL and triglyceride(TG)were higher than those in the non-invasive syndrome group(P<0.05).Gas formation was likely to occur in the abscess of the invasive syndrome group(P<0.05),and the differences were statistically significant.The treatment inefficiencies in the invasive syndrome group were higher than those in the non-invasive syndrome group(P<0.05).Conclusions:1.In case of fever and pleural effusion with unknown cause,the possibility of BLA should be considered.2.Klebsiella pneumoniae is the main pathogen of BLA in our hospital.Patients with obvious abdominal symptoms are likely suffering from Escherichia coli infection.If the patient's imaging examination shows gas formation in the abscess,he may be suffering from Klebsiella pneumoniae infection.3.If the patient has a history of biliary disease,malignant tumor,abdominal surgery,carbapenems antibiotics can be selected empirically.4.KPLA patients with diabetes mellitus,rheumatic diseases and gas formation in the abscess cavity should be alert to the occurrence of invasive syndrome.If the patient has eyes discomfort,we should pay attention to examine the eyes,and timely multidisciplinary combined treatment should be given to improve the prognosis of the patients.