细菌性肝脓肿临床特点及病原学特征分析
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摘要
目的分析某院细菌性肝脓肿(BLA)临床特点及微生物学特征。方法回顾性分析94例病原学阳性的BLA患者人口学特点、临床表现、实验室及影像学指标,分析其病原学构成及预后。结果 BLA以男性多见(71.2%),发热(>38℃)多见(75.6%),潜在疾病为糖尿病(47.9%)和肝胆系统疾病(44.7%),早期实验室检查白细胞升高多见(83.0%),影像学上肝右叶病变多见(56.4%)。肺炎克雷伯菌在血液及引流液培养中检出率为77.3%,其中含产超广谱β-内酰胺酶(ESBLs)6株(8.0%),对除氨苄西林外的其他试验药物耐药率低(≤16.0%),对碳青霉烯类药物均敏感。大肠埃希菌检出率为7.2%,其中含产碳青霉烯酶肠杆菌1株(14.3%),对除氨苄西林和妥布霉素外的其他试验药物耐药率低(≤57.1%),对替加环素敏感。治愈87例(92.6%),死亡1例(1.1%)。结论 BLA病原学以肺炎克雷伯菌最常见,其次为大肠埃希菌,全部对替加环素敏感。动态监测该地区BLA的病原菌及耐药性,对合理选择抗菌药物及优化治疗方案有重要意义。
Objective To analyze the clinical features and microbiological characteristics of bacterial liver abscess(BLA)in a hospital.Methods The demographic characteristics,clinical manifestation,laboratory and imaging indicators of 94 BLA patients with positive etiology were analyzed retrospectively,and their etiological components and prognosis were also analyzed.Results BLA mostly occurred in males(71.2%).Fever(>38℃)was common(75.6%),the potential diseases were diabetes(47.9%)and hepatobiliary diseases(44.7%),the leukocyte elevation(83.0%)in early laboratory examination and the right hepatic lobe lesion in imageology(56.4%)were common.The detection rate of Klebsiella pneumoniae in blood and drainage fluid culture was 77.3%,including 6 strains(8.0%)producing extended spectrumβ-lactamase(ESBLs).The drug resistance rate was low(≤16.0%)except ampicillin while were sensitive to carbapenems.The detection rate of Escherichia coli was 7.2%,including 1 strain(14.3%)of enterobacterium produced carbapenemase.The drug resistance rate to other tested drugs was low(≤57.1%)except for ampicillin and tobramycin,while was sensitive to tigacycline.In this group,87 cases(92.6%)were cured and 1 case died(1.1%).Conclusion Klebsiella pneumoniae as the BLA etiology is the most common,followed by Escherichia coli.All of them are sensitive to tigecycline.Dynamically monitoring the pathogens and drug resistance of BLA infection in this area,has an important significance for rationally selecting antibiotics and optimizing the treatment scheme.
Objective To analyze the clinical features and microbiological characteristics of bacterial liver abscess(BLA)in a hospital.Methods The demographic characteristics,clinical manifestation,laboratory and imaging indicators of 94 BLA patients with positive etiology were analyzed retrospectively,and their etiological components and prognosis were also analyzed.Results BLA mostly occurred in males(71.2%).Fever(>38℃)was common(75.6%),the potential diseases were diabetes(47.9%)and hepatobiliary diseases(44.7%),the leukocyte elevation(83.0%)in early laboratory examination and the right hepatic lobe lesion in imageology(56.4%)were common.The detection rate of Klebsiella pneumoniae in blood and drainage fluid culture was 77.3%,including 6 strains(8.0%)producing extended spectrumβ-lactamase(ESBLs).The drug resistance rate was low(≤16.0%)except ampicillin while were sensitive to carbapenems.The detection rate of Escherichia coli was 7.2%,including 1 strain(14.3%)of enterobacterium produced carbapenemase.The drug resistance rate to other tested drugs was low(≤57.1%)except for ampicillin and tobramycin,while was sensitive to tigacycline.In this group,87 cases(92.6%)were cured and 1 case died(1.1%).Conclusion Klebsiella pneumoniae as the BLA etiology is the most common,followed by Escherichia coli.All of them are sensitive to tigecycline.Dynamically monitoring the pathogens and drug resistance of BLA infection in this area,has an important significance for rationally selecting antibiotics and optimizing the treatment scheme.
引文
[1]路倩倩,马承泰,顾华丽,等.细菌性肝脓肿的病原学及临床分析[J].中国感染与化疗杂志,2016,16(6):722-725.
[2]袁兴贵,张伟阳,方兴亮,等.细菌性肝脓肿患者的病原菌分布及耐药性分析[J].中国卫生检验杂志,2016,26(19):2874-2876.
[3]吴莹,张俊君,高欣,等.98例细菌性肝脓肿患者临床特点分析[J].华南国防医学杂志,2018,32(6):403-406.
[4]周义,李昌平.252例细菌性肝脓肿临床病原学特点及耐药性分析[J].重庆医学,2018,47(11):1551-1554.
[5]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:428-430.
[6]刘江福,林成祖,柯邵鹏,等.110例细菌性肝脓肿的临床分析[J].中国卫生标准管理,2017,8(2):42-44.
[7]MANDOUR S S,FARAHAT H G,MOHAMED H M.Preoperative subpterygial mitomycin C injection versus limbal conjunctival autograft transplantation for prevention of pterygium recurrence[J].J Ocul Pharmacol Ther,2011,27(5):481-485.
[8]ZAKY K S,KHALIFA Y M.Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery[J].Indian J Ophthalmol,2012,60(4):273-276.
[9]张婷婷,袁喆.细菌性肝脓肿病原学分布及耐药性分析[J].西部医学,2017,29(5):679-684.
[10]陈帆,张艳亭,李爽,等.542例肝脓肿临床分析[J].南京医科大学学报(自然科学版),2016,36(7):850-854.
[11]TIAN L T,YAO K,ZHANG X Y,et al.Liver abscesses in adult patients with and without diabetes mellitus:an analysis of the clinical characteristics,features of the causative pathogens,outcomes and predictors of fatality:a report based on a large population,retrospective study in China[J].Clin Microbiol Infect,2012,18:314-330.
[12]许建新,纪明锁,任敬,等.糖尿病患者细菌性肝脓肿的临床特征与病原菌分布[J].中华医院感染学杂志,2016,26(7):154-1547.
[13]邵亚丽.糖尿病合并肝脓肿的特征[J].肝脏,2017,22(2):143-146.
[14]张成龙,郭晶晶,贾田野,等.75例细菌性肝脓肿临床和病原学特点分析[J].传染病信息,2014,27(3):157-158.
[15]郭晶晶,王慧珠,李娟,等.39例细菌性肝脓肿患者的病原学分布及耐药性分析[J/CD].中华实验和临床感染病杂志(电子版),2015,9(1):69-72.
[16]王春燕,邱厚兵,彭胡.肺炎克雷伯菌肝脓肿微生物学特征和耐药情况分析[J].国际检验医学杂志,2017,38(21):2955-2957.
[17]张金龙,蔡建刚,张舒琪.69例细菌性肝脓肿临床特点及其细菌药敏分析[J].中华灾害救援医学,2017,10(5):597-598.
[18]李登云,杨利萍,姜新华,等.肝脓肿合并糖尿病患者感染病原菌分布及药敏分析[J].中华医院感染学杂志,2017,27(22):5116-5118.
[19]LO J Z,LEOW J J,NG P L,et al.Predictors of therapy failure in a series of 741adult pyogenic liver abscesses[J].J Hepatobiliary Pancreat Sci,2015,22(2):156-165.
[20]ABBAS M T,KHAN F Y,MUHSIN S A,et al.Epidemiology,clinical features and outcome of liver abscess:a single reference center experience in Qatar[J].Oman Med J,2014,29(4):260-263.
[21]吴柳,张洁,孙琳,等.肺炎克雷伯菌肝脓肿70例临床分析[J].中国感染与化疗杂志,2018,18(1):11-17.
[22]贾艳,孙长江,韩文瑜,等.肺炎克雷伯菌研究进展[J].微生物学杂志,2006,26(5):75-78.
[23]XU S,WANG Y,CHEN J,et al.Application of ultrasound-guided percutaneous intrahepatic portal vein catheterization with antibiotic injection for treating unliquefied bacterial liver abscess[J].Hepatol Res,2017,47(3):e187-e192.
[24]杨学平,张瑶,王连双,等.超声引导精准治疗获得性免疫缺陷综合征合并肝脓肿的疗效及安全性评[J/CD].中华实验和临床感染病杂志(电子版),2017,11(3):277-281.
[2]袁兴贵,张伟阳,方兴亮,等.细菌性肝脓肿患者的病原菌分布及耐药性分析[J].中国卫生检验杂志,2016,26(19):2874-2876.
[3]吴莹,张俊君,高欣,等.98例细菌性肝脓肿患者临床特点分析[J].华南国防医学杂志,2018,32(6):403-406.
[4]周义,李昌平.252例细菌性肝脓肿临床病原学特点及耐药性分析[J].重庆医学,2018,47(11):1551-1554.
[5]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:428-430.
[6]刘江福,林成祖,柯邵鹏,等.110例细菌性肝脓肿的临床分析[J].中国卫生标准管理,2017,8(2):42-44.
[7]MANDOUR S S,FARAHAT H G,MOHAMED H M.Preoperative subpterygial mitomycin C injection versus limbal conjunctival autograft transplantation for prevention of pterygium recurrence[J].J Ocul Pharmacol Ther,2011,27(5):481-485.
[8]ZAKY K S,KHALIFA Y M.Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery[J].Indian J Ophthalmol,2012,60(4):273-276.
[9]张婷婷,袁喆.细菌性肝脓肿病原学分布及耐药性分析[J].西部医学,2017,29(5):679-684.
[10]陈帆,张艳亭,李爽,等.542例肝脓肿临床分析[J].南京医科大学学报(自然科学版),2016,36(7):850-854.
[11]TIAN L T,YAO K,ZHANG X Y,et al.Liver abscesses in adult patients with and without diabetes mellitus:an analysis of the clinical characteristics,features of the causative pathogens,outcomes and predictors of fatality:a report based on a large population,retrospective study in China[J].Clin Microbiol Infect,2012,18:314-330.
[12]许建新,纪明锁,任敬,等.糖尿病患者细菌性肝脓肿的临床特征与病原菌分布[J].中华医院感染学杂志,2016,26(7):154-1547.
[13]邵亚丽.糖尿病合并肝脓肿的特征[J].肝脏,2017,22(2):143-146.
[14]张成龙,郭晶晶,贾田野,等.75例细菌性肝脓肿临床和病原学特点分析[J].传染病信息,2014,27(3):157-158.
[15]郭晶晶,王慧珠,李娟,等.39例细菌性肝脓肿患者的病原学分布及耐药性分析[J/CD].中华实验和临床感染病杂志(电子版),2015,9(1):69-72.
[16]王春燕,邱厚兵,彭胡.肺炎克雷伯菌肝脓肿微生物学特征和耐药情况分析[J].国际检验医学杂志,2017,38(21):2955-2957.
[17]张金龙,蔡建刚,张舒琪.69例细菌性肝脓肿临床特点及其细菌药敏分析[J].中华灾害救援医学,2017,10(5):597-598.
[18]李登云,杨利萍,姜新华,等.肝脓肿合并糖尿病患者感染病原菌分布及药敏分析[J].中华医院感染学杂志,2017,27(22):5116-5118.
[19]LO J Z,LEOW J J,NG P L,et al.Predictors of therapy failure in a series of 741adult pyogenic liver abscesses[J].J Hepatobiliary Pancreat Sci,2015,22(2):156-165.
[20]ABBAS M T,KHAN F Y,MUHSIN S A,et al.Epidemiology,clinical features and outcome of liver abscess:a single reference center experience in Qatar[J].Oman Med J,2014,29(4):260-263.
[21]吴柳,张洁,孙琳,等.肺炎克雷伯菌肝脓肿70例临床分析[J].中国感染与化疗杂志,2018,18(1):11-17.
[22]贾艳,孙长江,韩文瑜,等.肺炎克雷伯菌研究进展[J].微生物学杂志,2006,26(5):75-78.
[23]XU S,WANG Y,CHEN J,et al.Application of ultrasound-guided percutaneous intrahepatic portal vein catheterization with antibiotic injection for treating unliquefied bacterial liver abscess[J].Hepatol Res,2017,47(3):e187-e192.
[24]杨学平,张瑶,王连双,等.超声引导精准治疗获得性免疫缺陷综合征合并肝脓肿的疗效及安全性评[J/CD].中华实验和临床感染病杂志(电子版),2017,11(3):277-281.
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