| Objective To investigate the clinical characteristics,pathogenic distribution and drug sensitivity of BLA,and to provide help for the diagnosis and treatment of BLA.Methods The clinical data of 339 BLA patients admitted to our hospital from January 2012 to May 2019 were collected,and the clinical characteristics,pathogenic distribution and drug sensitivity results of BLA were analyzed retrospectively.From196 patients with positive etiological results,7 cases of complex pathogenic bacteria were excluded,189 patients with positive etiology were divided into KPLA group and NKPLA group to analyze the clinical characteristics of KPLA.Results1.Clinical characteristics of BLA Among the 339 BLA patients,there were 235 males with an average age of(55.76±15.23)years,and 104 females with an average age of(63.40±12.24)years.The most common basic diseases included diabetes in 125 cases(36.87%)and biliary diseases in 120 cases(35.40%).The most common clinical symptoms were fever(90.26%)and abdominal pain(56.05%).The average length of stay was(15.03±10.99)days,and the recovery rate was 97.05%.2.Pathogenic distribution of BLA The culture results of 196 cases were positive,7 cases had two combinations of pathogenic bacteria,and 203 strains of pathogenic bacteria were detected.There were179 strains of gram-negative bacteria,mainly 123(60.59%)strains of Klebsiella Pneumoniae and 43(12.68%)strains of Escherichia coli.There were 24 strains of gram-positive bacteria,including 11(5.42%)strains of Enterococcus,11(5.42%)strains of Streptococcus,and 2(0.99%)strains of Staphylococcus.3.Drug sensitivity test results The sensitivity rate of Klebsiella Pneumoniae to antibiotics except for furantoin, ampicillin and ampicillin sodium sulbactam sodium was more than 90%,to ampicillin was only 0.81%,and the resistance rate to imipenem was 4.88%.The sensitivity rate of Escherichia coli to amikacin and imipenem was above 90%,to cefotetan,furantoin,piperacillin sodium sulbactam sodium was about 70%-80%,to ceftriaxone was only13.95%,and to ampicillin was less than 10%.The sensitivity rate of gram-positive bacteria to tigecycline,linezolid and vancomycin was 100%.4.Clinical characteristics of KPLA Among 119 cases of KPLA positive for single bacterial culture,there were 86 males and 33 females,with an average age of(56.20±14.24)years and an average length of stay of(15.16±10.59)days.The recovery rate was 96.64%.The prevalence of diabetes in KPLA group was higher than that in NKPLA group,but biliary diseases,tumor and operation history were rare(P<0.05).Hemoglobin,alanine aminotransferase and fasting blood glucose were higher in KPLA group(P<0.05).The common complications were impaired liver function(32.77%)and pleural effusion(22.69%).Endophthalmitis,meningitis,adrenal abscess and prostatic abscess were found in 6 cases.5.Treatment and outcome of BLA All patients received intravenous anti-infection treatment,among which,283 cases were treated by combined hepatic puncture and catheter drainage,and 12 cases were treated by surgical operation.The average length of stay was more than 2 weeks,and the recovery rate was more than 85%.Conclusions1.BLA tends to occur in elderly men,and fever is the most common clinical manifestation.Abdominal symptoms are often atypical.The clinical prognosis is good.2.Klebsiella Pneumoniae and Escherichia coli are the most common pathogens of BLA,and gram-positive bacteria are rare.3.Klebsiella Pneumoniae has a high sensitivity to antibiotics except ampicillin and furantoin,while Escherichia coli has a low sensitivity to antibiotics used commonly.4.Diabetes is a common cause of KPLA,and biliary tract diseases,tumors,and abdominal surgeries are seen in NKPLA commonly.5.The clinical characteristics of KPLA are atypical,with mild anemia,severe liver function damage,and high fasting blood glucose.Some patients may develop extra-hepatic metastatic infection. |
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