Objectives: To analyze the clinical features and the pathogenic constituent of patients with pyogenic liver abscess (PLA), and to find the risk factors of the multidrug resistance (MDR) pyogenic liver abscess (MDR-PLA) for effective therapy in the PLA patients.
Methods: We reviewed the PLA patients with antibiotics susceptibility test, who admitted to Xiangya Hospital of Central South University from Jan. 2010 to Dec. 2019. A total of 157 cases were divided into 2 groups: an MDR-PLA group (n=52) and a non-MDR-PLA group (n=107). The clinical data such as age, symptoms, laboratory and imaging data, and etiological test especially drug sensitivity test of the 2 groups were collected. Logistic regression analysis was performed for the risk factors of MDR-PLA.
Results: Anorexia (90.38%) and abdominal pain (63.46%) were more common in the MDR-PLA group than those in the non-MDR-PLA group (P<0.05). The proportions of patients with hepatolithiasis (34.62%) and biliary tract operation (38.62%) were higher in the MDR-PLA group than those in the non-MDR-PLA group (P<0.05). Klebsiellapneumoniae (59.94%) was the most common pathogen, which was sensitive to most of the antibiotics, while Escherichia coli and Enterococcus had lower drug sensitivity than Klebsiella lebsiella pneumoniae. The MDR-Enterococcus was 6.5 times of non-MDR-Enterococcus. And the multidrug resistance Klebsiella pneumoniae was 3.4 times of non-MDR-Klebsiella pneumoniae. Logistic regression analysis showed that hepatolithiasis (OR=4.895, 95% CI 1.455 to 16.463, P=0.001) and biliary tract operation (OR=3.860, 95% CI 1.156 to 12.889, P=0.004) were the risk factors for the MDR-PLA patients.
Conclusions: The PLA patients with hepatolithiasis and billary tract operation history and the pathogenic bacterium of Escherichia coli and Enterococcus bacteria should be alerted for MDR bacterial infection.
目的: 分析细菌性肝脓肿(pyogenic liver abscess，PLA)患者的临床及病原学特点，探讨多重耐药(multidrug resistance，MDR)细菌性肝脓肿(MDR-PLA)的危险因素。方法: 回顾性收集中南大学湘雅医院2010年1月至2019年12月入院的157例肝脓肿患者资料，将其分为MDR-PLA组(52例)和非MDR-PLA组(105例)，比较两组患者的临床特点及病原学特点。采用logistic回归分析MDR-PLA的危险因素。结果: 与非MDR-PLA组比较，MDR-PLA组出现食欲下降(90.38%)、腹痛(63.46%)、合并胆道系统结石(34.62%)及肝胆系统手术史(38.46%)的患者占比更高(P<0.05)。肺炎克雷伯杆菌(59.44%)为主要致病菌，其药物敏感性相对较好，MDR菌株是非MDR菌株的3.4倍；肠球菌及大肠埃希菌药物敏感性相对较差，肠球菌株中MDR菌株是非MDR菌株的6.5倍。Logistic回归分析显示合并胆道系统结石(OR=4.895，95% CI：1.455~16.463，P=0.001)及肝胆系统手术史(OR=3.860，95% CI：1.156~12.889，P=0.004)是MDR-PLA的危险因素。结论: 合并胆道系统结石、有肝胆系统手术史和病原菌为肠球菌及大肠埃希菌的PLA患者需警惕MDR细菌感染。.
Keywords: clinical features; multidrug resistance; pyogenic liver abscess; risk factors.