目的 探讨细菌性肝脓肿的临床及病原学特点,为临床治疗提供参考。方法 回顾解放军总医院第八医学中心肝胆外科收治的112例细菌性肝脓肿患者的临床资料,根据是否合并肝胆基础疾病分为肝胆病组和无肝胆病组,对两组的临床表现、实验室及影像学检查、病原学分布、治疗方式进行比较。结果 64例(57.1%)合并肝胆基础疾病,临床表现主要是发热(92.9%)、腹痛(58%)和寒战(41.1%),无肝胆病组的寒战发生率和纤维蛋白原(Fib)升高率显著高于肝胆病组(χ2=4.21、5.35,P<0.05),而肝胆病组TBil升高率更常见(χ2=11.17,P=0.001)。脓肿以单发(65.2%)为主,右半肝居多(65.2%)。两组在脓肿大小、数目、部位、气腔形成方面无统计学差异。112例患者有85例进行病原学检查,53例(62.4%)阳性,肺炎克雷伯菌(29/53,54.7%)是最主要的致病菌且对常用抗生素敏感,而合并肝胆基础疾病的患者大肠埃希菌感染更常见(P<0.05)。结论 细菌性肝脓肿以肺炎克雷伯菌为主且对常用抗生素敏感,大肠埃希菌感染多见于合并肝胆基础疾病的患者,对抗生素的耐药性更为复杂,应根据药敏试验合理选用抗生素。
Abstract
Objective To identify the clinical and pathogenic characteristics of patients with bacterial liver abscess (BLA) so as to provide reference for clinical treatment. Methods The clinical data on 112 patients with BLA treated in the 8th Medical Center of PLA General Hospital between January 2015 and December 2020 was retrospectively analyzed. The demographic data, clinical presentation,laboratory examinations,imaging features,microbiological tests and treatments were compared between the group with underlying hepatobiliary diseases and the one without these diseases. Results The age of the patients averaged (58.82±12.36) years. There were 64 cases (57.1%) combined with underlying hepatobiliary diseases. The dominating clinical manifestation of these patients was fever (92.9%),followed by abdominal pain (58%) and chills (41.1%). Chills and elevated Fib were more common in patients without underlying hepatobiliary diseases (χ2=4.21,5.35,P<0.05). However,elevated TBil was more common in patients with underlying hepatobiliary diseases. The majority of cases of BLA were solitary (65.2%) and localized in the right hepatic lobe (65.2%). There was no statistically significant difference in size,number,location or gas-formation of abscesses between the two groups. Bacteria culture was available in 85 patients and 53 cases (62.4%) were positive. The results of bacteria culture showed Klebsiella pneumoniae (54.7%) was the leading pathogen that was sensitive to most antimicrobial agents. Escherichia coli was commonly seen in patients with underlying hepatobiliary diseases (P<0.05). Conclusions The dominant pathogen is Klebsiella pneumoniae that is sensitive to antimicrobials. Escherichia coli infection is commonly seen in patients with underlying hepatobiliary diseases and antibiotic resistance is also more complex so that antibiotics should be used with caution according to results of drug sensitivity test.
关键词
肝脓肿 /
肺炎克雷伯菌 /
大肠埃希菌
Key words
liver abscess /
Klebsiella pneumoniae /
Escherichia coli
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