Retrospective Analysis Of Clinical Characteristics Of Pyogenic Liver Abscess

Objective:To analyze the clinical characteristics of pyogenic liver abscess(PL A),reduce the incidence of invasive syndrome in patients with PLA,guide the ratio nal use of antibiotics and improve the prognosis.Methods:The clinical characteristics(The general information,clinical manifestati ons,basic diseases),laboratory,etiology,imaging,treatment and prognosis of PLA,alway s the differences between Klebsiella pneumoniae liver abscess(KLA)and other kinds of Klebsiella pneumoniae liver abscesse(non-KLA),the invasive Klebsiella pneumo niae liver abscess and non-invasive Klebsiella pneumoniae liver abscess admitted i n the Affiliated Yantai Yuhuangding Hospital of Qingdao University from 2013 to2017 were analyzed.Results:A total of 606 cases were collected.Their clinical characteristics were as follows:the ratio of male to female was 1.32:1,and the average age was(60.3+14.1)years.The most common clinical manifestation was fever(92.9%).Diabetes mellitus(39.6%)and biliary tract infection(22.4%)were the main basic diseases.The most co mmon complications were pleural effusion(31.8%)and pulmonary infection(26.7%).L aboratory tests showed that the percentage of increased?-glutamyl transferase(GGT)(71.4%)was higher than that of alanine aminotransferase(ALT)(50.6%),aspartate ami notransferase(AST)(45.4%)and alkaline phosphatase(ALP)(54.7%).Etiology:Single bacterial infection was the main pathogen(93.0%).Klebsiella pn eumoniae(K pneumoniae)(73.1%)was the most common pathogen in pus culture an d blood culture,followed by Escherichia coli(E coli)(9.7%).The bacterial detection r ate increased year by year.According to the analysis of K pneumoniae and E coli,produce extended-spectrum?-lactamase(ESBLs)bacteria(11.4%)were more than 50%re sistant to cephalosporins,quinolones,aminoglycosides and compound neotamine,and more than 90%sensitive to carbapenems and beta-lactamase inhibitors,mainly E col i.Imaging:Abscesses were mostly located in the right lobe(67.4%),mostly single(73.3%)and the size of abscesses ranged from 5 to 10 cm(45.5%)with gas shadow(11.3%).Treatment and outcome:Anti-infection combined with local puncture and draina ge was the main treatment(74.7%).Among them,the use rate of compound beta-lact amase inhibitors(cefoperazone/sulbactam,piperacillin/tazobactam)was the highest(36.0%),followed by carbapenems(31.5%)and cephalosporins(31.3%).Most patients were discharged after active treatment(93.4%),aged over 65 years(P=0.013),low-levelhemoglobin(HGB)(P=0.003),platelet(PLT)(P=0.001),albumin(ALB)(P<0.001),higher levels of total bilirubin(TBIL)(P=0.019),direct bilirubin(DBIL)(P=0.004),aspartate aminotransf erase(AST)(P=0.005).Multiple pus cavity(P=0.001),gas shadow(P=0.001),complication s of multiple organ failure(P<0.001),septic shock(P=0.001),and peritoneal effusion(P<0.001)were risk factors affecting prognosis.Compared with other kinds of K pneumoniae liver abscesses(Non-KLA),K pne umoniae liver abscesse(KLA)group had lower age(P<0.001),higher prevalence of dia betes mellitus(P<0.001),lower proportion of biliary tract infection,biliary tract operat ion history and tumor history(P<0.001),higher proportion of C-reactive protein(CRP)(P=0.01),more prone to anemia(P<0.001),creatinine(Cr).The increase rate was lower(P=0.005),the right lobe liver abscess rate was higher(P=0.008),and the effective rat e was higher after treatment(P=0.018),the difference was statistically significant(P<0.05).Age and diabetes were independent risk factors for K pneumoniae infection(P<0.05).Compared with non-invasive K pneumoniae hepatic abscess,the peak temperatu re of invasive K pneumoniae group was lower(P=0.002),leucocyte(WBC)increased more significantly(P=0.009),neutrophil percentage(N%)increased more(P=0.019),blood glucose(GLU)was higher(P=0.044),albumin(ALB)was lower(P=0.003),pleural effusio n ratio was higher(P=0.019).Higher(P<0.001),worse(P=0.028),the difference was stati stically significant(P<0.05).Conclusion:The incidence of pyogenic liver abscess is related to age and sex.It is a consumptive and multi-complication disease.Anemia and thrombocytopenia affect the prognosis.K pneumoniae is the main pathogenic bacteria.Diabetes melli tus is an independent risk factor for its infection.It is prone to invasive infection of lung,eye and brain,causing serious consequences and high disability rate and mortality rate.At present,the drug-resistant bacteria are mainly E coli,K pneumoni ae has a low drug resistance rate,high sensitivity to carbapenems and beta-lactama se inhibitors.Antibiotics combined with local puncture and drainage of abscess are the main treatment methods,which can achieve good therapeutic effect.