Etiology,Susceptibility Test And Clinical Analysis Of Single-center Bacterial Liver Abscess

Background and Objective:Liver is the largest substantive organ in our body.It plays an important role in the body such as bile secretion,substance metabolism,coagulation,detoxification,phagocytosis,immunity and so on.Liver can be infected by bacteria,fungi,viruses,parasites and other microorganisms,forming infectious liver disease.Liver abscess is one of the most common infectious liver diseases in clinic,including bacterial liver abscess and amebic liver abscess.BLA accounts for about 80% of all liver abscesses.Because of the rapid onset and rapid progress of BLA,it is easy to cause septicemia and liver function damage.Even under active treatment,there will be 4% ~ 6% mortality rate,so it is still a fatal disease in clinical practice.In recent years,the increase in chronic diseases such as diabetes,the development of auxiliary examination techniques such as color ultrasound and CT,as well as the widespread use of antibiotics,and the intervention of various surgical techniques,have changed our understanding of the etiology,diagnosis and treatment of liver abscess.Pathogenic bacteria can enter the liver through the biliary system,hepatic arteries,portalvein,broken wounds of the liver,or spread through infected tissues nearby,causing inflammatory reactions and resulting in abscesses.Diabetes is also considered to be an important risk factor.In the past,Escherichia coli,Staphylococcus aureus and anaerobic streptococcus were the main pathogenic bacteria of BLA,but now they are mainly Klebsiella pneumoniae and Escherichia coli.With the continuous development of interventional techniques,the surgical treatment of hepatic abscess has undergone fundamental changes.From the previous open abscess incision and drainage,it has been transformed into the current percutaneous transhepatic drainage of hepatic abscess.Materials and Methods: The clinical data of 186 patients with bacterial liver abscess admitted to the first Hospital of Jilin University from October 2017 to August 2018 were retrospectively analyzed,such as clinical manifestations,imaging manifestation,bacterial culture results,drug sensitivity test results and treatment methods.Results: The main clinical features of BLA were hyperpyrexia,shivering,abdominal pain and hepatic percussion pain.Most abscesses are solitary,mostly located in the right lobe of the liver,with septum.There was no statistical difference between age and sex in imaging manifestations of abscess.The main pathogenic bacteria of BLA were Klebsiella pneumoniae,and there were statistical differences with the number and etiology of abscess.The susceptibility of Klebsiella pneumoniae to imipenem,amikacin,meropenem,cefepime,piperacillin / tazobactam was over 98%.Escherichia coli was more than 90% sensitive to imipenem and meropenem.Surgical intervention is dominated by ultrasound-guided percutaneous transhepatic drainage of hepatic abscess.Conclusion:For patients with liver abscess without gallbladder diseases,especially the one number of liver abscess,this study recommends early empirical and adequate use of ?-lactamase antibiotics(such as cephalosporins for the third generation and the fourth generation)or the compound preparation containing ?-lactamase inhibitor(such as piperacillin / tazobactam,etc.).Early adequate use of carbapenem such as imipenem,meropenem and other carbapenem is recommended for liver abscess related to gallbladder diseases.Then the drug sensitivity was adjusted according to the results of drug sensitivity.