Analysis Of Clinical Characteristics Of 198 Bacterial Liver Abscess Cases

Objective: To retrospectively analyze the clinical characteristics of bacterial liver abscess,and compare the clinical differences of bacterial liver abscess with or without diabetes mellitus,diabetic ketoacidosis and sepsis,respectively,so as to guide the clinical individualized diagnosis and treatment.Methods: The clinical data of hospitalized patients with liver abscess from November2017 to November 2020 were collected,analyzed and summarized.The patients were divided into groups according to whether they were complicated with diabetes,diabetic ketoacidosis and sepsis respectively,and the clinical characteristics of the groups were then compared,including clinical manifestations,laboratory findings,medical imaging features,pathogen examinations,comorbidity and complications,and treatment regimen,etc.SPSS20 software was used for statistical analysis.Results: 1.198 patients with bacterial liver abscess were enrolled in this study.92.4%of them were cryptogenic liver abscess with unknown causes,and 43.9% of them were complicated with diabetes mellitus.Complications associated with bacterial liver abscess included pulmonary infection(37.4%),pleural effusion(28.8%),ascites(2.0%),sepsis(19.2%),septic shock with multiple organ failure(3.5%),invasive syndrome(4.0%).The pathogen positive rate of pus culture(73.8%)was significantly higher than that of blood culture(34.0%)(P < 0.05).The related pathogens included 100 cases of Gram-negative bacteria and 13 cases of Gram-positive bacteria,in which the most common Gram-negative bacteria was Klebsiella pneumoniae(79.6%),followed by Escherichia coli(5.3%).The ESBL positive rate of Klebsiella pneumoniae(7.8%)was significantly lower than that of Escherichia coli(83.3%)(P < 0.05).Of all the antibiotics tested in this study,the sensitivity rate of ampicillin was only 3%,while cephalosporins,quinolones,aminoglycosides,carbapenems and other antibiotics were generally sensitive with total sensitivity rate of more than 85%.The sensitivity rates of piperacillin / tazobactam and amikacin were 100%.2.198 patients with liver abscess were split into sepsis group(n=38)and nonsepsis group(n=160).There was significant difference(P < 0.05)between the two groups in terms of the incidence of pulmonary infection,pleural effusion,invasive syndrome(78.9%,55.3%,21.1% in sepsis group and 27.5%,22.5%,0% in nonsepsis group,respectively).Endophthalmitis was a common invasive syndrome with a poor prognosis.3.198 patients were classified into diabetic group(n=87)and non-diabetic group(n=111).The incidence of abdominal pain in diabetic group(28.7%)was significantly lower than that in non-diabetic group(50.5%)(P < 0.05).There were statistically significant differences in WBC counting,neutrophil percentage,total protein,albumin,creatinine and urea nitrogen between the two groups(P < 0.05).In addiction,there was significant differences in the incidence of sepsis between diabetic group(26.4%)and non-diabetic group(13.5%),as well as in the use rate of carbapenem between diabetic group(44.8%)and non-diabetic group(27.0%)(P < 0.05).4.Based on wethere there was diabetic ketoacidosis,87 patients in diabetic group were further divided into ketoacidosis group(n=14)and non-ketoacidosis group(n=73).There was statistically significant difference(P < 0.05)between the two groups in terms of the incidence of sepsis and septic shock with multiple organ failure(64.3%,21.4% in ketoacidosis group and 19.2%,0% in non-ketoacidosis group,respectively).Conclusion: 1.Bacterial liver abscess is commenly complicated with diabetes mellitus,most of which are cryptogenic liver abscess with unknown etiology.The most common pathogen is Klebsiella pneumoniae,followed by Escherichia coli,which are generally resistant to ampicillin,and sensitive to cephalosporins,quinolones,aminoglycosides,carbapenems and other antibiotics.Piperacillin has the highest sensitivity rate,which can be used as the prefered choice for empirical treatment.Bacterial liver abscess with sepsis is more likely to be complicated with pulmonary infection,invasive syndrome.Endophthalmitis is a common invasive syndrome with poor prognosis and early screening and intervention are urgently required for patients with bacterial liver abscess who have ocular symptoms in clinical practice.2.Patients with bacterial liver abscess complicated with diabetes have lower incidence of abdominal pain and therefore are more likely to be missed in diagnosis clinically.Bacterial liver abscess with diabetes and ketoacidosis is more likely to progress to sepsis.Therefore,It is necessary to relax the restriction of antibiotic escalation in this condition.