侵袭性肺炎克雷伯菌肝脓肿综合征12例临床特征分析

Clinical analysis of 12 cases of invasive Klebsiella pneumoniae liver abscess syndrome

目的总结分析侵袭性肺炎克雷伯菌肝脓肿综合征(IKLAS)患者的临床特征,以提高对该病的认识。方法回顾性分析株洲市中心医院2020年1月至2023年1月确诊为IKLAS的12例患者的临床资料。结果12例患者中男性6例,女性6例,年龄49~90(65.3±12.2)岁,9例合并糖尿病。主要临床表现为发热(9例),畏寒(6例),寒战(4例),恶心、呕吐(2例),上腹痛(2例),乏力、纳差(2例),咳嗽、咳痰(1例),意识障碍(1例),咯血(1例)。8例患者白细胞计数水平升高,10例淋巴细胞计数减少,3例血小板计数减少。所有患者C反应蛋白、降钙素原水平均升高。所有患者血清白蛋白水平均降低。7例患者丙氨酸氨基转移酶水平升高,7例门冬氨酸氨基转移酶水平升高。8例患者肝脓肿位于肝右叶,1例位于肝左叶,3例发生于双侧;7例为单发脓肿,5例为多发脓肿。病原学标本主要来源于肝脓液和血液培养,分别有10例和5例阳性。侵袭部位或系统主要为肺和血液系统,分别为10例和5例。12例患者培养鉴定的肺炎克雷伯菌多为敏感菌株,总体耐药率低。所有患者经抗感染治疗,其中10例患者行肝脓肿穿刺引流。11例患者治疗后好转出院,1例因脓毒症休克死亡。结论IKLAS的临床症状多样,多合并糖尿病,主要侵袭肺和血液系统,及时诊断、积极筛查肝外其他转移性感染部位、及时脓肿引流和合适的抗菌药物治疗可提高患者生存率。

Objective To analyze the clinical features of patients with invasive Klebsiella pneumoniae liver abscess syndrome(IKLAS).Methods The clinical data of 12 patients diagnosed as IKLAS in Zhuzhou Central Hospital from January 2020 to January 2023 were retrospectively analyzed.Results Among 12 patients there were 6 males and 6 females with an mean age of 65.3±12.2 years(49-90).Nine patients were complicated with type 2 diabetes.The main clinical manifestations were fever(n=9),chill(n=6),shiver(n=4),nausea and vomiting(n=2),upper abdominal pain(n=2),fatigue and anepithymia(n=2),cough and expectoration(n=1),disturbance of consciousness(n=1)and hemoptysis(n=1).The leukocyte count was increased in 8 cases,lymphocyte count decreased in 10 cases,and platelets count decreased in 3 cases.C-reactive protein and procalcitonin levels were elevated,while serum albumin levels were lowered in all patients.The alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were increased in 7 cases each.Liver abscess was located in the right lobe in 8 cases,in the left lobe in 1 cases,and in both lobes in 3 cases.There were 7 patients with single abscess,and 5 patients with multiple abscesses.The etiology was confirmed by liver pus culture(n=10)and blood culture(n=5),respectively.The main sites of invasion were lung and blood stream(n=10 and n=5,respectively).The majority of Klebsiella pneumoniae isolates were antibiotic sensitive strains and the overall drug resistance rate was relatively low.All patients were given antibiotics,and 10 of them also received liver abscess puncture drainage.After treatment,11 patients were discharged,and 1 died of septic shock.Conclusions Patients with IKLAS exhibit diverse clinical symptoms,most patients are complicated with diabetes,and the main sites of invasion are in the lungs and blood stream.Timely diagnosis,active screening of extrahepatic infection sites,effective drainage of abscess and appropriate antibiotic treatment can improve the survival of patients.