社区获得性细菌性肝脓肿患者的临床和病原学特征

Clinical and pathogenic characteristics of community acquired pyogenic liver abscess

目的了解社区获得性细菌性肝脓肿(pyogenic liver abscess,PLA)患者的临床和病原学特征。方法回顾性分析2013年3月至2018年9月苏州大学附属第一医院收治的172例社区获得性PLA患者的临床资料,包括临床特征、病原学分布、治疗与转归。统计学处理采用χ^(2)检验。结果172例社区获得性PLA患者中,发热158例(91.9%),腹痛69例(40.1%);单发脓肿143例(83.1%),位于肝右叶141例(82.0%);106例(61.6%)为隐源性PLA。156例患者进行了病原学检测,共有99例(63.5%)病原学检测结果阳性,92例(92.9%)为单一菌株感染,7例(7.1%)为混合感染。共检出致病菌115株,主要菌株为肺炎克雷伯菌(Klebsiella pneumoniae,KP)71株(61.7%)和大肠埃希菌(Escherichia coli,EC)21株(18.3%);其中17株产超广谱β-内酰胺酶,2株为耐碳青霉烯类肠杆菌。61例KP-PLA患者中,合并糖尿病42例(68.9%),胆道系统疾病16例(26.2%),恶性肿瘤1例(1.6%);15例EC-PLA患者中,合并糖尿病6例,胆道系统疾病9例,恶性肿瘤4例;两组差异均有统计学意义(χ^(2)=4.307、4.784、8.536,均P<0.05)。经抗菌药物单用或联合引流术治疗后,167例(97.1%)患者病情好转。结论PLA临床表现不典型,主要致病菌为KP和EC,合并糖尿病、胆道系统疾病和恶性肿瘤的患者易发生PLA。

Objective To investigate the clinical and pathogenic characteristics of community acquired pyogenic liver abscess(PLA).Methods The clinical data of 172 patients in First Affiliated Hospital of Soochow University with community acquired PLA from March 2013 to September 2018 were retrospectively collected,including clinical characteristics,distribution of the causative pathogens,treatment regimens and outcomes.Chi-square test was used for statistical analysis.Results There were 158(91.9%)cases with fever,69(40.1%)cases with abdominal pain among 172 PLA cases.One hundred and forty-three(83.1%)were solitary,and 141(82.0%)cases localized in right hepatic lobe.One hundred and six(61.6%)cases were PLA of cryptogenic origin.There were 156 cases underwent etiology detection,with the positive etiology detection of 99(63.5%)cases.Ninety-two(92.9%)cases were infected with a single strain,and seven(7.1%)cases were infected with mixed strains.A total of 115 strains of bacteria were isolated.The main strains included 71(61.7%)Klebsiella pneumoniae(KP),21(18.3%)Escherichia coli(EC),among which 17 were extended spectrumβlactamase,and two carbapenem-resistant Enterobacteriaceae.Among the 61 KP-PLA patients,42(68.9%)cases were diagnosed with diabetes,16(26.2%)cases with biliary diseases,and one(1.6%)case with malignant tumor.Among the 15 EC-PLA patients,six cases were diagnosed with diabetes,nine cases with biliary diseases,and four cases with malignant tumors.There were statistically significant differences(χ^(2)=4.307,4.784 and 8.536,respectively,all P<0.05).After admission,the patients were treated with antibiotics alone or combined with drainage.One-hundred and sixty-seven(97.1%)cases got improved.Conclusions The clinical manifestations of PLA are atypical,and the dominant pathogens are KP and EC.The risk factors of PLA are diabetes mellitus,biliary diseases and malignant tumors.