某三甲医院细菌性肝脓肿的临床特征分析及抗感染药物选择评价

Analysis of clinical characteristics of pyogenic liver abscess and evaluation of selection of anti-infection drugs in a tertiary hospital

目的:分析苏州大学附属第一医院细菌性肝脓肿临床特征,评价抗感染药物选择的合理性。方法:回顾性分析2018年1月—2021年12月因细菌性肝脓肿收住于苏州大学附属第一医院且脓肿液或血标本微生物培养阳性的患者临床资料,探讨临床表现、实验室指标和病原学特点;并制订抗感染药物选择的评价标准,结合患者病情和病原学结果评价经验性和目标抗感染药物选择的合理性。结果:共纳入101例患者,临床表现以发热、食欲缺乏和乏力为主,伴随炎症指标升高和肝酶指标异常。共分离培养出病原菌110株,主要为肺炎克雷伯菌88株(80.0%)和大肠埃希菌11株(10.0%),仅7株为产超广谱β-内酰胺酶的肠杆菌科细菌。6例患者入院前血培养阳性,入院时即进行目标抗感染治疗。95例经验性和101例目标治疗方案以联合用药为主,分别有69例(72.6%)和69例(68.3%),抗感染药物选择评价合理病例仅有17例(17.9%)和30例(29.7%),不合理情况主要包括联合用药不合理、过度使用特殊级抗菌药物和未根据药敏结果调整抗感染药物品种等。结论:该院细菌性肝脓肿抗感染治疗不合理用药现象突出,需要采取措施以规范用药合理性。

OBJECTIVE To analyze the clinical characteristics and the rationality of anti-infection regimens of pyogenic liver abscess(PLA)in a tertiary hospital.METHODS The clinical data of patients admitted to a tertiary hospital for PLA with positive pathogenicity from January 2018 to December 2021 were retrospectively analyzed aiming to explore the clinical manifestations,laboratory indexes and pathogenetic characteristics.The rationality of empirical and targeted anti-infection regimens was evaluated by setting evaluation criteria,in combination with the patient’s condition and etiologic outcomes.RESULTS A total of 101 patients were included,and the main clinical manifestations were fever,poor appetite and fatigue,accompanied by elevated inflammatory indexes and abnormal liver enzyme indexes.Among the 110 pathogenic strains,88(80.0%)were Klebsiella pneumoniae,11(10.0%)were Escherichia coli,and only7 were ESBL-producing enterobacteria.6 patients were tested positive in preadmission blood culture and received targeted anti-infection treatment after admission.Empirical(95 cases)and targeted(101 cases)treatment regimens were predominantly conducted in the form of combination drugs in69(72.6%)and69(68.3%)cases,respectively,with only 17(17.9%)and 30(29.7%)of anti-infection regimens evaluated as reasonable.The unreasonable situations mainly included irrational combination of antibiotics,non-standardized use of special grade antibiotics,and failure to adjust the anti-infection regimen according to the drug sensitivity results.CONCLUSION The irrational application of antibiotics for PLA treatment is prominent in the hospital,and efforts should be taken to regulate the rationality of therapeutic regimen.