肺炎克雷伯菌肝脓肿侵袭性综合征10例临床分析

Clinical analysis of ten cases of invasive Klebsiella pneumoniae liver abscess syndrome

目的:通过分析肺炎克雷伯菌肝脓肿侵袭性综合征患者的流行病学、临床表现及影像学检查,提高对高毒力肺炎克雷伯菌的临床认识。方法:对2015-06—2019-07期间北京医院经血培养或肝脓肿脓液培养检测阳性、合并存在其他部位影像学明确存在转移感染的10例肺炎克雷伯菌肝脓肿侵袭性综合征患者的病例资料进行回顾分析。结果:10例患者中,男6例,女4例,年龄43~88岁。均为社区获得性感染,其中糖尿病8例,糖耐量异常1例,均无肝胆基础疾病。临床表现以发热、寒颤、纳差为主,不具特异性。糖化血红蛋白及肝脓肿大小与患者是否存在侵袭性感染无明显相关性,患者血小板下降与预后无明显相关。死亡患者的血乳酸水平较存活患者明显升高。病原学检查可见10例患者肺炎克雷伯菌均为敏感菌。本研究收集的10例侵袭性感染中,累及肺部8例,眼内炎3例,脑脓肿1例,感染性休克4例,坏死性筋膜炎1例,累及泌尿系1例,其中肝脓肿合并感染性休克患者预后较差。结论:肺炎克雷伯菌肝脓肿侵袭性感染多合并糖尿病病史,临床表现无特异性,一旦怀疑肺炎克雷伯菌肝脓肿应尽早行影像学及病原学检查进一步明确并尽早抗感染治疗,还应注意筛选肝外表现。

Objective:To improve the understanding of Klebsiella pneumoniae,the epidemiology,clinical manifestations and imaging characteristcs of patients with Klebsiella pneumoniae liver abscess invasive syndrome were analysed.Method:From June 2015 to July 2019,ten patients with invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS),diagnosed with blood culture or liver abscess pus culture in Beijing Hospital,were retrospectively analyzed.Result:Among the ten patients,six were male and three were female,aged 43 to 88 years old.All infections were community acquired,eight cases with diabete mellitus,one case with impaired glucose tolerance,no patient with hepatobiliary disease.Their clinical manifestations are fever,chills,and poor appetite.Glycated hemoglobin and liver abscess size were not significantly related to the presence of invasive infections in patients,and the decline of platelets was not significantly related to patients’prognosis.However,lactate were significantly higher in the dead than the survivors.Etiological examination showed that all Klebsiella pneumoniae were sensitive to most antibiotics.Of all ten cases,eight involved the lungs,three endophthalmitis,one brain abscess,four septic shock,one necrotizing fasciitis,and one urinary tract infection.Patients with liver abscess and septic shock have a poor prognosis.Conclusion:IKLAS is common in people with diabetes,and the clinical manifestations are asymptomatic.Once Klebsiella pneumoniae liver abscess is suspected,imaging and etiological examination should be performed as soon as possible to further clarify and early anti-infective treatment.Attention should also be paid to screen for extrahepatic manifestations.