Analysis Of Clinical Features And Etiological Changes Of Bacterial Liver Abscess

【Objective】Part 1 Analysis of clinical features of biliary and cryptogenic liver abscessThis study aims to compare the similarities and differences between the clinical characteristics of patients with biliary liver abscesses(Pyogenic liver abscesses of biliary origin,PLAB)and cryptogenic liver abscesses(Pyogenic liver abscesses of cryptogenic origin,PLAC),and provide basis for the early differential diagnosis of PLAB and PLAC.Part 2 Analysis of etiological changes of bacterial liver abscessThis study aims to discuss and analyze the etiology and causes of bacterial liver abscess(BLA),provide assistance for early diagnosis and treatment of BLA.【Method】Part 1 Analysis of clinical features of biliary and cryptogenic liver abscessRetrospectively analyze the complete clinical data(general information,clinical manifestations,comorbid diseases,laboratory examination,imaging examination,etiological results and treatment)of patients with BLA in Shenzhen Second People’s Hospital from January 1,2011 to December 31,2020.According to whether BLA patients related to biliary diseases are classified into PLAB group(83 cases)and PLAC group(104 cases),and compare the clinical data of patients in the PLAB and PLAC groups,analyze the similarities and differences in the clinical characteristics of the two groups,to provide a basis for the early identification of PLAB and PLAC.Part 2 Analysis of etiological changes of bacterial liver abscessRetrospectively analyze of the clinical data of 187 BLA patients admitted to Shenzhen Second People’s Hospital from January 2011 to December 2020,according to the patient’s admission time,divide the BLA patients admitted from January 2011 to December 2015 and January 2016 to December 2020 into group A(first 5 years,n=64cases)and group B(last 5 years,n=123 cases).By comparing the general data,comorbidities and etiological results of BLA patients in the first and last 5 years,explore the reasons for the changes in its etiology,provide assistance for early diagnosis and treatment of BLA.【Result】Part 1 Analysis of clinical features of biliary and cryptogenic liver abscess1.General information: Among 187 BLA patients,83 cases(44.4%)were in PLAB group,with a male-to-female ratio of 1.31:1;104 cases(55.6%)were in the PLAC group,and the male to female ratio was 2.25:1.Both PLAB and PLAC groups were mostly male,and there was no difference in incidence between male and female(P > 0.05).Patients in the PLAB group were older than those in the PLAC group(58.10±13.69 vs 52.37±17.15),and there was a significant difference in age between the two groups(P < 0.05).Both PLAB and PLAC are more likely to occur in middleaged people(61.4% vs 49.0%),although the age of onset of PLAB and PLAC was not different between the middle-aged group and the elderly group(P>0.05),the incidence of PLAC in the youth group was higher than that in the PLAB group,and the difference was significant(P<0.05).PLAB patients had a slightly longer hospital stay than PLAC patients(14.36±9.17 vs 13.36±9.69),but there was no significant difference in hospital stay between the two groups(P>0.05).2.Clinical manifestations: The most common clinical manifestation of the two groups of patients was fever,followed by right upper abdominal pain,respiratory symptoms,nausea and jaundice.The symptoms of right upper abdominal pain(72.3%vs 35.6%),nausea(32.5% vs 17.3%)and jaundice(31.3% vs 15.4%)were more common in the PLAB group than in the PLAC group,there were statistical differences(P<0.05).3.Complicated diseases: Both the PLAB group and the PLAC group had diabetes(33.7% vs 50.0%),hypertension(32.5% vs 19.2%),liver cysts(13.3% vs 4.8%),and pleural effusion(2.4% vs 10.6%),there are significant differences(P <0.05).In addition,the PLAB group had more patients with malignant tumors(19.3% vs 1.9%)than the PLAC combination,there is a significant difference(P<0.05).There were 6cases of liver cancer,5 cases of colon cancer,4 cases of pancreatic cancer and 1 case of cholangiocarcinoma among the patients with malignant tumors in the PLAB group.There were 2 cases of breast cancer in the PLAC group of malignant tumor patients.4.Laboratory examination: Among the liver function indexes,the increase of TBil(34.5±34.9 vs 22.5±24.9),γ-GT(217.4±198.0 vs 212.7±181.1)and ALT(89.9±156.6 vs 68.9±60.2)in PLAB group was significantly higher than that in PLAC group.Only the increase of TBIL was statistically significant(P < 0.05).The Alb level of PLAB group and PLAC group was similar(33.1±6.0 vs 34.0±5.9),and there was no statistical difference(P>0.05).There was no significant difference in N%,WBC and Hb between the two groups(P>0.05).The fasting blood glucose detected for the first time after admission in the PLAC group was higher than that of the PLAC group(7.9±3.7 vs 6.8±2.5),significant difference(P<0.05).5.Imaging examination: In both PLAB and PLAC groups,single abscess(63.9%vs 77.9%)was the most common,most of which occurred in the right lobe of the liver(69.9% vs 77.9%),and the maximum diameter of abscess cavity was 3-8cm(49.4% vs69.2%).Compared with the PLAB group,patients with single abscess,air cavity formation,and abscess cavity maximum diameter of 3-8cm were more common in the PLAC group,and there were statistical differences(P<0.05).6.Microbial culture: The positive rate of bacterial culture in 177 patients was48.6%.The main infections of patients in the PLAB and PLAC groups were E.coli(57.9% vs 16.7%)and Kp(31.6% vs 72.9%).Among them,the positive detection rate of E.Coli in the PLAB group was significantly higher than that in the PLAC group(57.9%vs 16.7%),the positive detection rate of Kp was lower than that of the PLAC group(31.6% vs 72.9%),The two groups of patients have significant differences in the detection rates of E.Coli and Kp(P<0.05).7.Treatment: Both PLAB and PLAC are treated with antibiotics combined with abscess puncture and drainage(60.2% vs 76.0%).Patients in the PLAB group received more antibiotics combined with surgery than the PLAC group(24.1% vs 3.8%),and the difference was statistically significant(P<0.05).The effective rate of treatment in the PLAB group was 90.4%,and the effective rate in the PLAC group was 88.1%.There was no significant difference in the treatment results between the PLAB group and the PLAC group(P>0.05).Part 2 Analysis of etiological changes of bacterial liver abscess1.General information: The incidence of BLA in the first and last 5 years was more common in men(64.1% vs 63.4%),and there was no statistical difference between male and female(P>0.05).The average age of onset of BLA patients was slightly older than that of group A(55.46±15.59 vs 53.84±16.62),and there was no statistical difference(P>0.05).There was a significant difference in the number of days of hospitalization between the two groups of patients,and the hospital stay in the last 5years was significantly shorter than that of the first 5 years(12.96±9.83 vs 15.42±8.55)(P<0.05).The number of cases of BLA is gradually increasing,among which the number of cases of PLAB has a downward trend,while the number of cases of PLAC has an upward trend(P<0.05).2.Complicated diseases: There are more BLA patients with diabetes in the next5 years than in the previous 5 years(50.4% vs 28.1%),there are fewer BLA patients with biliary diseases in the next 5 years than in the previous 5 years(31.7% vs 68.8%),there were statistical differences(P<0.05).In the last 5 years,the number of patients with diabetes in PLAC increased compared with the previous 5 years(35.8% vs 12.5%),and there was a statistical difference(P<0.05).In the next 5 years,the number of people with diabetes in PLAC was more than that in PLAB(35.8% vs 14.6%),which was statistically different(P<0.05).Both PLAB and PLAC had an increasing trend in the number of patients with diabetes.Among them,PLAB had a more significant increase in the number of patients with diabetes(P<0.05).3.Microbial culture: The positive rate of bacterial culture in BLA patients is lower,at 48.6%.Among them,the positive rate in the first 5 years was 35.8%,and the positive rate in the next 5 years was 59.4%,Kp and E.Coli infections were more common in both groups.The detection rate of Kp in BLA patients in the next 5 years was significantly higher than that in the previous 5 years(66.7% vs 31.0%),and the detection rate of E.Coli in BLA patients in the first 5 years was higher than that in the following 5 years(51.7% vs 26.3%),there were statistical differences(P<0.05).In the first 5 years,the positive rate of E.Coli of PLAB was higher than that of PLAC(41.4%vs 10.3%),while the positive rate of Kp culture was lower than that of PLAC(6.9% vs24.1%),both of which were statistically different(P<0.05).In the next 5 years,the positive rate of E.Coli of PLAB was higher than that of PLAC(17.5% vs 8.8%),while the positive rate of Kp culture was lower than that of PLAC(17.5% vs 49.1%),both of which were statistically significant(P<0.05).【Conclusion】1.In recent years,the incidence of BLA has shown an upward trend,among which the incidence of PLAC has increased significantly,especially those with diabetes,while the incidence of PLAB has shown a downward trend.2.PLAB patients are more common in right upper abdominal pain and jaundice,biliary diseases are the main pathogenic factors,E.Coli infection is the main cause,and the infection is significantly reduced;3.PLAC patients mainly have unexplained fever.Diabetes is a high risk factor for the onset of PLAC.Kp infection is the main cause,and infections are significantly increased.4.Increasing population aging and changes in disease spectrum have increased the risk of infectious diseases among middle-aged and elderly people,especially diabetic patients,thereby increasing the risk of BLA in custody.Among them,the incidence of PLAC has increased significantly;5.The rapid development of imaging technology and surgical diagnosis and treatment technology,etc.,enables early diagnosis and timely treatment of biliary diseases,reduces the occurrence of PLAB,and thus reduces the infection of intestinal bacteria;6.The widespread use of antibiotics enables effective control of infections at an early stage,but as the abuse of antibiotics leads to the development of drug resistance and even mutation of pathogenic bacteria,the effect of conventional antibiotic treatment is not good.