细菌性肝脓肿诊治的难点

Difficulties in diagnosis and treatment of pyogenic liver abscess

1986年首次报道了肺炎克雷伯菌肝脓肿伴肝外迁徙性感染,经系列研究后将此致病菌定义为高毒力肺炎克雷伯菌。目前医院临床微生物实验室不能区分高毒力肺炎克雷伯菌和普通肺炎克雷伯菌,因此给早期诊断和治疗带来了困难。胆肠吻合、胆道介入治疗和肝移植后胆道疾病已成为急性胆管炎反复发作的常见诱因,细菌性肝脓肿发病呈上升趋势,特别是多药耐药菌所致感染明显增加。本文就细菌性肝脓肿诊疗难点作一综述。

Klebsiella pneumoniae liver abscess accompanied by metastatic infectious complications was firstly reported in 1986.The pathogen was defined as Hypervirulent K.pneumoniae(hvKp)after a series of studies,which is an evolving pathotype and more virulent than classical K.pneumoniae(cKp).At present,it is difficult to distinguish hvKp and cKp in the clinical microbiology lab,which results in delay in early diagnosis and treatment on hvKp-related infections.Biliary tract diseases after cholangiojejunostomy,biliary interventional therapy and liver transplantation have become common causes of recurrent acute cholangitis.The incidence of bacterial liver abscess is on the rise,especially the infection caused by multidrug-resistant bacteria.This article reviews difficulties in the diagnosis and treatment of bacterial liver abscess.