| Objective:The incidence of lung abscess is not clear,but there are no large clinical studies to summarize its regularity,epidemiology,and clinical characteristics.This study explored the clinical characteristics of 230 cases of lung abscess in our hospital,the distribution characteristics and drug resistance of lung abscess pathogenic bacteria,and the risk factors of pulmonary abscess-related empyema(PARE).The purpose of the study is to improve the understanding of the disease.It is helpful to distinguish different pathogenic infections clinically,and provides reference for the early effective target antipathogenic empirical treatment of lung abscess.Method:A total of 230 cases of lung abscess diagnosed in a tertiary hospital in a province from January 1,2015 to December 31,2015 were collected,and clinical data of the patients(including clinical manifestations,pathogenic bacteria,and treatment outcomes)were retrospectively analyzed.Excluding 9 cases without pathogenic data,10 cases of mixed infection with positive and negative bacteria and 2 cases of anaerobic bacteria,209 patients were divided into gram-negative bacteria group(n=48),gram-positive bacteria group(n=24)and culture-negative group(n=137)according to pathogenic results,the differences in clinical characteristics between the groups were compared.According to whether they are combined with empyema,they were divided into PARE group(n=50)and non-empyema group(n=180).The differences in clinical data between the two groups were compared to explore the risk factors of PARE.Independent sample t test,non-parametric test,chi-square test or Fisher exact probability method were used for comparison between groups.Multivariate analysis was performed by binary logistic regression analysis.Result:The results of the study on 230 patients with lung abscess are shown below:1.Clinical features: The majority of lung abscesses in our hospital were male(80.43%),and the mean age was 58.34±12.64 years old.Diabetes mellitus was the most common underlying disease(41.3%).The main clinical manifestations were cough(88.70%),expectoration(83.00%)and fever(68.7%).Primary lung abscess and communityacquired lung abscess(CALA)were the main lung abscess in our hospital,accounting for 65.22% and 90% respectively.2.Distribution of pathogenic bacteria: Among 230 cases of lung abscess,pathogenic bacteria were detected in 84 cases,and a total of 100 pathogenic bacteria were detected.The main pathogens detected were aerobic bacteria.Among the gram-negative bacteria,Klebsiella pneumonia(KP)had 35 strains and Pseudomonas aeruginosa(Ps Ar)had 11 strains.Staphylococcus aureus and Streptococcus were the main gram-positive bacteria,16 and 12 strains were detected respectively.3.Resistance analysis of common pathogens: KP showed high resistance to ampicillin(96.55%),low resistance to ceftazidime(14.29%),piperacillin/tazobactam(15.15%),levofloxacin(15.15%)and imipenem(12.12%),and was fully sensitive to tigecycline.The drug resistance rates of Ps Ar to meropenem,imipenem and levofloxacin were higher than 30%,while Ps Ar was more sensitive to piperacillin/tazobactam(9.09%)and cefepime(9.09%).Staphylococcus and Streptococcus had high resistance to clindamycin(66.67% and 58.33%,respectively),and were all sensitive to linezolid and vancomycin.4.Analysis of the characteristics of different pathogenic groups: There was no statistical difference between the three groups in age,gender,combined cerebrovascular disease,fever,white blood cell count,and fasting blood glucose(P>0.05)There were differences among diabetes and malignant tumors,hospital-acquired lung abscess,fishy sputum,percentage of neutrophils,and albumin(P<0.05).Compared with the gram-positive bacteria group,the gram-negative bacteria group was more often associated with diabetes mellitus.Compared with the culture negative group,patients in the gram-negative bacteria group were more likely to have the characteristics of diabetes mellitus,hypoalbuminemia,HALA,and higher percentage of neutral lobulated nuclei,while the fishy sputum was common in the culture negative group.Malignancy and low albumin were more common in the gram-positive bacteria group than in the culture-negative group.(P < 0.05).5.Treatment and outcome: Quinolones(23.04%),carbapenems(18.26%),cefoperazone sodium sulbactam(16.09%)and third-generation cephalosporin antibiotics(7.39%)were commonly used drugs for empirical anti-infection in our hospital.The median hospital stay for lung abscess was 19 days;the median cost of treatment was 25,200 yuan.After treatment,219 patients were improved and discharged,of which 10 patients(4.35%)were cured by surgery.11 patients(4.78%)died.The common complications of lung abscess were hypoproteinemia(47.83%),anemia(38.70%)and empyema(21.74%).6.Pulmonary abscess-related empyema(PARE)risk factor analysis:Univariate analysis showed that smoking history,hemoptysis,chest pain,shortness of breath,albumin,detection of gram-positive bacteria and abscesses with a maximum diameter greater than5 cm were related factors for PARE(all P values <0.05).Multivariate logistic retrospective analysis showed that detection of gram-positive bacteria(OR 3.478,95%CI 1.291-9.366,P=0.014),chest pain(OR 2.734,95% CI 1.285-5.817,P=0.009)and abscess diameter greater than 5 cm(OR 2.142,95% CI 1.002-4.578,P = 0.049)were risk factors for PARE.Conclusion :In this study,it is found that the incidence of lung abscess is higher in males than in females.Diabetes mellitus is the most common underlying disease,and the clinical manifestations often showed long-term fever and respiratory symptoms such as cough and sputum.KP,Ps Ar,Staphylococcus aureus and Streptococcus are common pathogenic bacteria of lung abscess in our hospital.Patients with HALA,diabetes,and hypoalbuminemia are more likely to consider gram-negative bacteria.KP in our hospital has a high resistance rate to ampicillin,and Ps Ar has a high resistance rate to imipenem and levofloxacin.Detection of gram-positive bacteria,chest pain,and abscess diameter greater than 5 cm are independent risk factors for PARE. |
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