肺炎克雷伯菌肝脓肿与大肠埃希菌肝脓肿临床特点对比分析

目的肺炎克雷伯菌肝脓肿(KPLA)与大肠埃希菌肝脓肿(ECLA)为临床上最常见的两种细菌性肝脓肿,分析这两种肝脓肿的临床特征,为早期诊断及有效治疗提供参考。方法回顾性分析2005年3月-2018年7月空军军医大学第二附属医院收治的371例肝脓肿患者资料,其中病原学检查阳性145例。比较KPLA与ECLA患者的临床特点、实验室检查、影像学检查及预后。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ^2检验或Fisher精确检验。采用多因素logistic回归分析预后的影响因素。结果145例病原学检查阳性患者中,肺炎克雷伯菌培养阳性66例,大肠埃希菌培养阳性42例。与KPLA患者相比,ECLA更好发于年龄较大人群(t=-2.250,P=0.027),多合并胆道疾病(χ^2=10.019,P=0.002)、腹部手术史(χ^2=27.481,P<0.001)、肿瘤(χ^2=17.745,P<0.001),多出现复发性肝脓肿(χ^2=13.745,P<0.001)。KPLA好发于糖尿病患者(χ^2=17.505,P<0.001)。实验室检查方面,与KPLA患者相比,ECLA患者TBil水平较高(U=880.000,P=0.001),Alb(t=-2.625,P=0.010)、PLT(U=1719.000,P=0.036)水平降低。影像学分析显示,ECLA常见多发肝脓肿(χ^2=23.372,P<0.001),KPLA脓肿直径多大于5 cm(χ^2=7.637,P=0.006)。并发症方面,ECLA更易出现肺部感染(χ^2=18.857,P<0.001)和肺气肿(P=0.013)。ECLA易出现多重耐药菌,两组在治疗方面均多采用抗生素联合B超引导下穿刺引流。多因素logistic回归分析显示预后的影响因素为患者入院APACHEⅡ评分(比值比=0.049,95%可信区间:0.026~0.266,P<0.001)。结论ECLA多发生于年龄较大且合并胆道疾病患者,易复发,影像学常见多发性脓肿,易合并肺炎及肺气肿,ECLA产超广谱β-内酰胺酶阳性率较高,需早期合理应用抗生素。

Clinical features of Klebsiella pneumoniae liver abscess versus Escherichia coli liver abscess

Objective To investigate the clinical features of the two most common types of pyogenic liver abscess in clinical practice,Klebsiella pneumoniae liver abscess(KPLA)and Escherichia coli liver abscess(ECLA),and to provide a reference for early diagnosis and effective treatment.Methods A retrospective analysis was performed for the clinical data of 371 patients with liver abscess who were admitted to The Second Affiliated Hospital of Air Force Medical University from March 2005 to July 2018,among whom 145 patients tested positive for pathogen.KPLA patients and ECLA patients were compared in terms of clinical features,laboratory examination,radiological examination,and prognosis.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.A multivariate logistic regression analysis was used to determine the influencing factors for prognosis.Results Among the 145 patients that tested positive for pathogen,66 tested positive for Klebsiella pneumonia and 42 tested positive for Escherichia coli.Compared with the KPLA patients,the ECLA patients tended to have an older age(t=-2.25,P=0.027),biliary diseases(χ^2=10.019,P=0.002),a history of abdominal surgery(χ^2=27.481,P<0.001),tumor(χ^2=17.745,P<0.001),and a significantly higher proportion of individuals with recurrent liver abscess(χ^2=13.745,P<0.001).KPLA was often observed in patients with diabetes(χ^2=17.505,P<0.001).As for laboratory examination,compared with the KPLA patients,the ECLA patients had a significant increase in total bilirubin(U=880.000,P=0.001)and significant reductions in albumin(t=-2.625,P=0.010)and platelet count(U=1719.000,P=0.036).Radiological examination showed that there was a higher proportion of patients with multiple liver abscess in ECLA(χ^2=23.372,P<0.001),while KPLA often had an abscess diameter of>5 cm(χ^2=7.637,P=0.006).As for complications,the ECLA patients were more likely to develop pulmonary infection(χ^2=18.857,P<0.001)and emphysema(P=0.013).ECLA patients were more likely to have multidrug-resistant organisms,and most patients were treated with antibiotics combined with ultrasound-guided percutaneous drainage in both groups.The multivariate logistic regression analysis showed that Acute Physiology and Chronic Health EvaluationⅡscore on admission(odds ratio=0.049,95%confidence interval:0.026-0.266,P<0.001)was an influencing factor for prognosis.Conclusion ECLA is commonly seen in elderly patients with biliary diseases,with easy recurrence,multiple abscesses on radiological examination,and a high proportion of pulmonary infection and emphysema.There is a high positive rate of extended-spectrum beta-lactamases produced by ECLA,and therefore,antibiotics should be used reasonably in the early stage.