高毒力肺炎克雷伯菌肝脓肿11例临床分析

Clinical analysis of 11 cases of hypervirulent Klebsiella pneumoniae liver abscess

目的分析高毒力肺炎克雷伯菌(hvKP)肝脓肿的临床特征,为临床诊疗提供依据。方法回顾性分析11例肝脓肿患者的临床资料,总结其临床特征、实验室检查结果、病原学检查结果和治疗转归等。结果该11例患者分离的菌株全部为拉丝试验阳性的肺炎克雷伯菌,常见临床表现有发热、白细胞升高、血小板减少、低蛋白血症、低钠血症等,多数患者有糖尿病病史或未发现的糖尿病(82.0%),经抗菌药物或联合肝脓肿穿刺引流治疗,死亡率为27.3%。结论目前肝脓肿的主要致病菌为hvKP,侵袭性强。积极的血糖控制有助于减少该病的发生,强效的抗感染治疗联合肝脓肿穿刺引流有助于改善预后。

Objective To summarize the characteristics of liver abscess caused by hypervirulent Klebsiella pneumoniae for improving clinical diagnosis and treatment.Methods The clinical data of 11 patients with liver abscess were retrospectively analyzed.The clinical characteristics,laboratory test results,microbiological results and treatment,outcome were summarized.Results All of the 11 cases were caused by K.pneumoniae evidenced by positive string test.The common clinical manifestations were fever,leukocytosis,thrombocytopenia,hypoproteinemia,and hyponatremia.Most of the patients had diabetes mellitus or undiagnosed diabetes(82.0%).Three(27.3%)of the 11 patients died after treatment with antibiotics and/or liver abscess drainage.Conclusions The main pathogen of liver abscess is hypervirulent K.pneumoniae.Active glycemic control is helpful for reducing the incidence of liver abscess.Highly effective antimicrobial therapy combined with drainage may help improving the prognosis.