157例细菌性肝脓肿的临床特点及病原学分析

Clinical features and etiological analysis for 157 cases of pyogenic liver abscess

目的:分析细菌性肝脓肿(pyogenic liver abscess,PLA)患者的临床及病原学特点,探讨多重耐药(multidrug resistance,MDR)细菌性肝脓肿(MDR-PLA)的危险因素。方法:回顾性收集中南大学湘雅医院2010年1月至2019年12月入院的157例肝脓肿患者资料,将其分为MDR-PLA组(52例)和非MDR-PLA组(105例),比较两组患者的临床特点及病原学特点。采用logistic回归分析MDR-PLA的危险因素。结果:与非MDR-PLA组比较,MDRPLA组出现食欲下降(90.38%)、腹痛(63.46%)、合并胆道系统结石(34.62%)及肝胆系统手术史(38.46%)的患者占比更高(P<0.05)。肺炎克雷伯杆菌(59.44%)为主要致病菌,其药物敏感性相对较好,MDR菌株是非MDR菌株的3.4倍;肠球菌及大肠埃希菌药物敏感性相对较差,肠球菌株中MDR菌株是非MDR菌株的6.5倍。Logistic回归分析显示合并胆道系统结石(OR=4.895,95%CI:1.455~16.463,P=0.001)及肝胆系统手术史(OR=3.860,95%CI:1.156~12.889,P=0.004)是MDR-PLA的危险因素。结论:合并胆道系统结石、有肝胆系统手术史和病原菌为肠球菌及大肠埃希菌的PLA患者需警惕MDR细菌感染。

Objective:To analyze the clinical features and the pathogenic constituent of patients with pyogenic liver abscess(PLA),and to find the risk factors of the multidrug resistance(MDR)pyogenic liver abscess(MDR-PLA)for effective therapy in the PLA patients.Methods:We reviewed the PLA patients with antibiotics susceptibility test,who admitted to Xiangya Hospital of Central South University from Jan.2010 to Dec.2019.A total of 157 cases were divided into 2 groups:an MDR-PLA group(n=52)and a non-MDR-PLA group(n=107).The clinical data such as age,symptoms,laboratory and imaging data,and etiological test especially drug sensitivity test of the 2 groups were collected.Logistic regression analysis was performed for the risk factors of MDR-PLA.Results:Anorexia(90.38%)and abdominal pain(63.46%)were more common in the MDR-PLA group than those in the non-MDR-PLA group(P<0.05).The proportions of patients with hepatolithiasis(34.62%)and biliary tract operation(38.62%)were higher in the MDR-PLA group than those in the non-MDR-PLA group(P<0.05).Klebsiella pneumoniae(59.94%)was the most common pathogen,which was sensitive to most of the antibiotics,while Escherichia coli and Enterococcus had lower drug sensitivity than Klebsiella lebsiella pneumoniae.The MDR-Enterococcus was 6.5 times of non-MDREnterococcus.And the multidrug resistance Klebsiella pneumoniae was 3.4 times of non-MDR-Klebsiella pneumoniae.Logistic regression analysis showed that hepatolithiasis(OR=4.895,95%CI 1.455 to 16.463,P=0.001)and biliary tract operation(OR=3.860,95%CI 1.156 to 12.889,P=0.004)were the risk factors for the MDR-PLA patients.Conclusion:The PLA patients with hepatolithiasis and billary tract operation history and the pathogenic bacterium of Escherichia coli and Enterococcus bacteria should be alerted for MDR bacterial infection.