Clinical And Computed Tomography Features Of Extended-spectrum β-lactamase-producing Klebsiella Pneumoniae Liver Abscess

Objects: Objective to compare the clinical and CT features of extended spectrum beta lactamase(ESBL)positive and negative Klebsiella pneumoniae induced liver abscess(KPLA),and to analyze the risk factors of ESBL positive bacterial infection.Methods: The clinical data of 122 patients with first-episode liver abscess(16patients with ESBL positive infection and 106 patients with ESBL negative infection)in Shengjing Hospital Affiliated to China Medical University from January 2017 to January 2021 were retrospectively analyzed.The clinical features,drug sensitivity and CT features of ESBL positive and ESBL negative groups were compared,and the independent risk factors of ESBL positive bacterial infection were further explored by logistic multivariate analysis.Results: ESBL positive patients had longer hospital stay and higher recurrence rate,and the proportion of patients with history of biliary tract and gastrointestinal cancer was significantly higher than that of ESBL negative patients(75% vs.30.2%,P< 0.05);50% vs.12.3%,P < 0.05).Multivariate logistic regression showed that history of biliary tract disease(or,4.145,95% CI: 1.139 – 15.085,P = 0.031)and history of gastrointestinal cancer(or,4.282,95% CI: 1.227 – 14.939,P = 0.023)were independent risk factors for ESBL positive.Both groups were sensitive to carbapenems,but the resistance rates of ESBL positive strains to most commonly used antibiotics such as cefazolin(93.8% vs.6.60%,P < 0.001),ampicillin sulbactam(50% vs.2.83%,P <0.001)and aztreonam(68.8% vs.0.90%,P < 0.001)were significantly higher than those of ESBL negative strains.On CT findings,CT findings showed that Kp liver abscess with positive ESBL was often unilocular(P < 0.05).Conclusion: The history of biliary tract or digestive tract malignant tumor is associated with ESBL positive Klebsiella pneumoniae infection.Patients with positive ESBL have severe condition and high mortality.CT images are usually single chamber.Carbapenems are the main drugs for the treatment of ESBL positive Klebsiella pneumoniae.