新型冠状病毒肺炎疫情期间长春地区细菌性肝脓肿临床特征分析

Clinical features of bacterial liver abscess in the context of coronavirus disease 2019 in Changchun,China

目的分析长春新型冠状病毒肺炎(新冠)疫情发生期间细菌性肝脓肿患者的临床特征及流行病学特点。方法回顾性筛选2022年3月1日—6月30日吉林大学第一医院出院的37411例患者,最终纳入135例细菌性肝脓肿患者,收集临床资料并总结其临床特点,同时与2019—2021年同期的细菌性肝脓肿患者的发病情况及致病菌群进行比较分析。计量资料多组间比较采用Kruskal-Wallis H检验,计数资料多组间比较应用χ^(2)检验。结果细菌性肝脓肿患者占同期本院收治患者的0.36%,较往年有不同程度增长(χ^(2)=32.081,P<0.001)。135例细菌性肝脓肿患者的平均住院时间为11(6~18)d,住院时间较往年延长(H=9.223,P=0.026)。细菌性肝脓肿患者的白细胞计数、C反应蛋白水平较往年升高(H值分别为14.150、8.736,P值分别为0.003、0.033)。有69例(51.11%)患者行血培养,培养结果依次如下:无菌生长(59.42%),肺炎克雷伯菌(30.43%),大肠埃希菌(4.35%),脆弱拟杆菌(1.45%),屎肠球菌(1.45%),表皮葡萄球菌(1.45%),产酸克雷伯菌(1.45%)。有90例(66.67%)患者行脓液培养,培养结果如下:肺炎克雷伯菌(72.22%),无菌生长(14.44%),大肠埃希菌(4.44%),屎肠球菌(2.22%),铜绿假单胞菌(2.22%),鲍曼不动杆菌(1.11%),产气克雷伯菌(1.11%),产酸克雷伯菌(1.11%),铅黄肠球菌(1.11%)。127例(94.07%)患者经抗感染及超声引导下脓肿穿刺引流治疗后,病情好转至痊愈,3例(2.22%)患者在住院期间死亡。结论长春新冠疫情期间,本院肝脓肿患者较往年同期增加,住院时间延长,白细胞计数、C反应蛋白水平较往年升高,主要致病菌是肺炎克雷伯菌,大部分患者经治疗后好转。

Objective To investigate the clinical and epidemiological features of patients with bacterial liver abscess during the outbreak of coronavirus disease 2019(COVID-19)in Changchun,China.Methods A retrospective analysis was performed for 37411 patients who were discharged from The First Hospital of Jilin University from March 1 to June 30 in 2022,and finally 135 patients with bacterial liver abscess were included for analysis.Related clinical data were collected to summarize their clinical features,and these patients were compared with the patients with bacterial liver abscess in 2019-2021 in terms of disease onset and pathogen.The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups,and the chi-square test was used for comparison of categorical data between multiple groups.Results The patients with bacterial liver abscess accounted for 0.36%of the patients admitted to our hospital during the same period of time,which showed varying degrees of increase compared with the previous years(χ^(2)=32.081,P<0.001).The 135 patients with bacterial liver abscess had a mean hospital stay of 11(6-18)days,which was longer than that in the previous years(H=9.223,P=0.026).The patients with bacterial liver abscess had higher levels of white blood cell count and C-reactive protein(CRP)than the previous years(H=14.150 and 8.736,P=0.003 and 0.033).Among the 135 patients,69(51.11%)received blood culture,and the results showed sterile growth(59.42%),Klebsiella pneumoniae(30.43%),Escherichia coli(4.35%),Bacteroides fragilis(1.45%),Enterococcus faecium(1.45%),Staphylococcus epidermidis(1.45%),and Klebsiella oxytoca(1.45%).Among the 135 patients,90(66.67%)received pus culture,and the results showed Klebsiella pneumoniae(72.22%),sterile growth(14.44%),Escherichia coli(4.44%),Enterococcus faecium(2.22%),Pseudomonas aeruginosa(2.22%),Acinetobacter baumannii(1.11%),Klebsiella aerogenes(1.11%),Klebsiella oxytoca(1.11%),and Enterococcus casseliflavus(1.11%).Of all 135 patients,127(94.07%)were improved and cured after anti-infective therapy and ultrasound-guided abscess puncture and drainage,and 3 patients(2.22%)died during hospitalization.Conclusion During the outbreak of COVID-19 in Changchun,there are increases in the number of patients with liver abscess in our hospital,the length of hospital stay,and the levels of white blood cell count and CRP,with Klebsiella pneumoniae as the main pathogen,and most patients are improved after treatment.