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Objective:To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without diabetes mellitus (DM), to provide a reference for clinical diagnosis and treatment.Methods:Patients with bacterial liver abscesses hospitalized in Tongren Hospital, Shanghai Jiao Tong University School of Medicine from January 2016 to August 2021 were enrolled, and their clinical data were collected. The patients were divided into diabetic and non-diabetic groups for comparison according to whether they had comorbid DM. Statistical analysis was performed by chi-square test or Fisher′s exact test, and multivariate logistic regression analysis.Results:A total of 131 patients with bacterial liver abscesses were included, including 47 cases in the diabetic group and 84 cases in the non-diabetic group. The percentages of platelet count <100×10 9/L, C-reactive protein>10 mg/L, and total bilirubin>17.5 μmol/L were lower in the diabetic group than that in the non-diabetic group, and the differences were all statistically significant ( χ2=3.90, 6.44 and 5.56, respectively, all P<0.05). The percentage of multiple abscesses in the diabetic group was 10.6%(5/47), which was lower than 29.8%(25/84) in the non-diabetic group, and the difference was statistically significant ( χ2=6.24, P=0.012). The positive rate of pus culture for Klebsiella pneumoniae was 64.9%(24/37) in the diabetic group, which was higher than 41.5%(27/65) in the non-diabetic group, with a statistically significant difference ( χ2=5.13, P=0.023). The incidences of pleural effusion and abscesses at other sites in the diabetic group were 29.8%(14/47) and 10.6%(5/47), respectively, which were both higher than 14.3%(12/84) and 1.2%(1/84) in the non-diabetic group, respectively, and the differences were statistically significant ( χ2=4.55, Fisher′s exact test, both P<0.05). The proportion of hospital stays>21 d was 34.0%(16/47) in the diabetic group, which was higher than 16.7%(14/84) in the non-diabetic group, with a statistically significant difference ( χ2=5.15, P=0.023). DM (odds ratio ( OR)=2.654, 95% confidence interval ( CI) 1.020 to 6.907, P=0.046) and abscess maximum diameter>10 cm ( OR=11.045, 95% CI 4.493 to 27.154, P<0.001) were significant risk factors for hospital stay>21 d. Conclusions:Bacterial liver abscesses combined with DM are more common with single abscess, a higher rate of Klebsiella pneumoniae infection, and more likely to develop pleural effusions and abscesses at other sites. Liver abscesses>10 cm in maximum diameter and comorbid DM would prolong hospital stay.
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Objective To investigate the pathogenic bacterium distribution in bacterial liver abscess and sensitivity characteristics and utilization of antibiotics. Methods The clinical data of 125 patients with bacterial liver abscess, who were admitted to anting branch of our hospital from Oct. 2015 to Apr. 2017, were collected and analyzed retrospectively. The results of bacterial culture, drug resistance and use of antibiotics were investigated. Results Totally 94 patients were examined for pathogens, and 62 samples from 51 patients were positive to bacterial culture. A total of 62 strains of bacteria were detected, including 53 (85.48%) strains of Gram-negative bacteria, of which the most common bacteria were Klebsiella pneumoniae (33 strains) and Escherichia coli (10 strains), and 9 (14.52%) strains of Gram-positive bacteria, of which Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were rather common (2 strains in each). Extended-spectrum β-lactamase (ESBL)-producing strains accounted for 6.06% (2/33) and 60.0% (6/10) in Klebsiella pneumonia and Escherichia coli, respectively. Ceftriaxone sodium, cefoperazone/sulbactam sodium, and imipenem/cilastatin sodium had higher defined daily dose system resulting in drug utilization index 1. Conclusion The most common pathogens causing bacterial liver abscess are Gram-negative bacteria, mainly Klebsiella pneumoniae and Escherichia coli. Clinically, we should strengthen the management of antibiotics use, identify the pathogens as soon as possible, and select optimum drugs based on drug-susceptibility test results to reduce drug resistance rate.
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Objective: To evaluate the clinical efficacy and safety of Levornidazole and sodium chloride injection in treating patients with bacterial liver abscess. Methods: 94 patients with bacterial liver abscess who need anti-anaerobion treatment were enrolled in this study. And all of them were divided into observation group (47 cases) and control group (47 cases). The patients of observation group received intravenous drip infusion of Levornidazole and sodium chloride injection, while patients of control group received intravenous drip infusion of Omidazole injection. The dosage of two groups was 0.5g, 2 times/d, 5-10d per a course. The clinical efficiency, bacteriology efficiency and the occurrence rate of adverse reaction between two groups were compared and researched. Results: The differences of clinically effective rate and clearance rate of bacteria between observation group (95.74% and 93.33%) and control group (89.36% and 88.23%) were not significant (x2=0.62, x2=1.30, P>0.05). The difference of average hospital stay time between observation group (13.47 d) and control group (14.86 d) also was no significant (t=0.96, P>0.05). After the drug therapy, the occurrence rates of adverse reactions, included of gastrointestinal reaction, anaphylaxis and abnormal liver function, of observation group was no significantly lower than that of control group (x2=0.26, x2=0.51, x2=0.51, P>0.05). While the adverse reaction rate of central nervous system of observation group (0) was significant lower than that of control group(14.89%) (x2=5.56, P<0.05). Conclusion: Levornidazole treating the bacterial liver abscess can obtain significant efficacy and safety, and it has higher clinical application value.
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Bacterial liver abscess is a rare and life-threatening disease, and, clinically, its incidence has gradually increased in recent years. In terms of its treatment, percutaneous puncturing drainage combined with antibiotics has been the first-line therapeutic means, and surgical procedures are often used for patients in whom the interventional drainage is ineffective or in whom the liver abscess is complicated by abdominal disease that needs surgical management. Percutaneous catheter drainage and percutaneous fine needle aspiration, regarded as the two most commonly used interventional drainage methods, have been widely employed in the treatment of bacterial liver abscess; and percutaneous catheter drainage is more commonly adopted in clinical practice. Although the prognosis of bacterial liver abscess has been improved significantly, there is still a certain fatality rate. There is still no a well-accepted consensus on treatment guidelines. Moreover, there are still many controversies over the indications of percutaneous puncturing drainage. Based on a comprehensive review of the domestic and foreign literature, this paper aims to make a detailed introduction concerning percutaneous puncturing drainage for the treatment of bacterial liver abscess, focusing on its development history, curative effect and prognosis, and, in order to guide the clinical practice, the principles of the use of antibiotics, the comparison of clinical effect with surgery and the therapeutic indications will be also discussed.
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Objective To summarize the clinical characteristics of and our experience in managing Klebsiella pneumoniae liver abscess.Methods The clinical data of 323 patients with bacterial liver abscess treated at three hospitals in Shanghai from January 2013 to March 2016 were analyzed retrospectively.Results Bacterial culture Klebsiella pneumoniae was identified in 70 cases.Compared with the patients with K.pneumoniae,the patients without K.pneumoniae had significantly higher prevalence of biliary tract complications (P=0.038),higher neutrophil percentage (P=0.002) and greater abscess diameter (P=0.015).However,the patients with K.pneumoniae showed relatively higher rate of treatment failure.Invasive syndrome was identified in 7 (10％) of the patients with K.pneumoniae,such as endophthalmitis,meningitis.The patients with invasive syndrome showed significantly higher prevalence of biliary tract diseases (P=0.078),more severe thrombocytopenia at early stage (P=0.004) and higher serum bilirubin level (P=0.043).The patients receiving surgical treatment (surgical operation and ultrasound-guided puncture) were associated with significantly shorter hospital stay (15.5± 8.6)d than the patients managed with medical therapy alone (20.1 ± 17.4) d (P=0.029).Conclusions K.pneumoniae is one of the most common pathogens of bacterial liver abscess.K.pneumoniae is relatively susceptible to cephalosporins and fluoroquinolones.Attention should be paid to the incidence of invasive syndrome at early stage.Antimicrobial therapy should be administered timely,especially for the patients complicated with thrombocytopenia or apparent jaundice.Ultrasound-guided percutaneous drainage can shorten hospital stay and reduce mortality.
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Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without type 2 diabetes mellitus, in order to guide clinical diagnosis and treatment.Methods The clinical data of 110 patients with bacterial liver abscess at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.Among them, 45 cases with type 2 diabetes mellitus and 65 cases without type 2 diabetes mellitus were included in the study.The demographic data, clinical signs and symptoms, laboratory findings, pathogenic results, imaging findings, treatment and prognosis were compared between the two groups.Differences among the quantitative data with normal distribution were compared using t test, while count data were compared with χ2 test or Fisher exact test.Multivariate Logistic regression was used to determine the prognostic risk factors of two groups.Results Fever as initial symptom in diabetic group and non-diabetic group were 37 cases and 40 cases, respectively, while abdominal pain presented in 7 cases and 22 cases of the two groups, respectively, both with statistically significant difference (χ2=5.417 and 4.582, respectively, both P<0.05).As for laboratory examination, neutrophil counts in the two groups were (12.87±8.83)×109/L and (10.24±4.86)×109/L, respectively, the percentages of neutrophils were 0.841±0.077 and 0.799±0.103, respectively, albumin levels were (28.36±4.65) g/L and (30.67±6.16) g/L, respectively, with statistically significant difference (t=2.010, 2.317 and-2.265, respectively, all P<0.05).Patients with elevated blood urea nitrogen in the two groups were 13 cases and 8 cases, respectively, patients with elevated creatinine were 9 cases and 4 cases, respectively, with statistically significant difference (χ2=4.733 and 4.892, respectively, both P<0.05).In diabetic group, pus culture was positive in 13 out of 19 cases, and blood culture was positive in 7 out of 21 cases.In non-diabetic group, pus culture was positive in 9 out of 13 cases, and blood culture was positive in 6 out of 25 cases.The positive rates of Klebsiella pneumoniae in the two groups were 37.5% (15/40) and 15.8% (6/38) , respectively, with statistically significant difference (χ2=4.669, P=0.031).The effective rates of the two groups with glycemic control were 84.4% (38/45) and 84.6% (55/65), respectively, and the mortality rates of the two groups were 2.2% (1/45) and 1.5% (1/65), respectively.Multivariate Logistic regression showed that multiple abscess (OR=34.61, 95% CI: 1.601-748.457, P=0.024) was prognostic risk factor and invasive intervention (OR=0.028, 95%CI: 0.001-0.984, P=0.049) was protective factor in the diabetes mellitus group.Hypoalbuminemia (OR=14.793, 95% CI: 1.605-136.322, P=0.017) and the history of abdominal surgery within two years (OR=7.624, 95% CI: 1.294-44.913, P=0.025) were prognostic risk factors in the non-diabetic group.Conclusions Patients with bacterial liver abscess showing symptoms of severe infection in diabetic group are more frequently than patients in non-diabetic group.Klebsiella pneumoniae infection rate is also higher in diabetic group.Patients with bacterial liver abscess and diabetes mellitus should receive antibiotic treatment combined with invasive therapy in time.
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Objective To compare the clinical effect of hepatic artery perfusion of antibiotics with that of intravenous administration of antibiotics in treating pyogenic liver abscess which is unsuitable for puncture drainage management. Methods Between October 2010 and October 2013, a total of 32 cases with bacterial liver abscesses which were unsuitable for puncture drainage management were encountered at the Third Affiliated Hospital of Wenzhou Medical University. The patients were divided into group A (n = 15) and group B (n = 17). Hepatic arterial perfusion of antibiotics was carried out in the patients of group A, while intravenous administration of antibiotics was employed in the patients of group B. Percutaneous puncture drainage was adopted in the patients when their imaging examination showed liquefaction within the lesion. Results The hospitalization time, recovery time of body temperature, hemogram recovery time and liquefaction extent of the lesion in group A were much better than those in group B , and the differences were statistically significant (P < 0.05). Conclusion Hepatic arterial perfusion of antibiotics is an important and effective treatment for bacterial liver abscesses.
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This retrospective analysis showed that the most frequent pathogen causing bacterial liver abscess was Klebsiella pneumoniae in 138 patients.Compared with the patients without diabetes mellitus,it was found that:( 1 ) the percentage of diabetic patients having typical abdominal pain was lower ( P ＜ 0.05 ) ; ( 2 ) neutrophilic granulocytosis was more marked,but albumin and hemoglobin levels were lower in diabetic patients( P＜0.05 ) ; ( 3 )more diabetic patients were complicated with urinary tract infection and suffered from septicemia( P＜0.05 ) ; (4) the clinical course of treatment in diabetic patients was much more prolonged( P＜0.05 ).
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OBJECTIVE To observe the clinical efficacy of cefminox for the treatment of bacterial liver abscess. METHODS Totally 118 patients with bacterial liver abscess were treated with cefminox 2 g iv drip 12 h or 8 h for(5-10 d),then with cefminox 1 g in drip 12 h for 21-35 d. RESULTS The total cure rate was 89.4%,the overall efficacy rate was 97.6%,and side effect rate was 2.4%. CONCLUSIONS Cefminox is an effective antibiotic in treating bacterial liver abscess.
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Objective To explore the clinical value of u ltrasound-guided percutaneous aspiration and drainage for bacterial liver absces s in children. Methods Under the guidance of ultrasonography, 15 children with bacterial hepatic abscess underwent percutaneous aspiration or drainage. Among them, 9 were given percutaneous aspiration for 1~4 times, and 6 underwent percutaneous drainage. Results Percutaneous aspirati on or drainage was successfully accomplished in all the 15 children, 14 of whom were cured. The hospital stay was 15~42 days (mean, 26.3 days). No bleeding or b ile leakage happened. Follow-up for 4~12 months (mean, 6.8 months) in 11 childre n showed no recurrence. One patient with no improvement left hospital of his own accord. Conclusions Ultrasound-guided percutaneous aspiration and drainage is a feasible option for the treatment of liver abscess in childre n.
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Objective: To summarize the experience in diagnosis and surgical treatment of bacterial liver abscess.Methods: The diagnosis and treatment of 67 patients with bacterial liver abscess were reviewed retrospectively.Results: The main clinical manifestations and signs were pains in the right upper abdomen,fever,tenderness of right upper abdomen,hepatic tenderness.Blood routine showed WBC increased significantly in most cases.B-Ultrasoundgraphy should be the first choice for diagnosis.Percutaneous and transhepatic cholangiography drainage of bacterial liver abscess can be used for most cases,which was simple and safe.Conclusion: The choice of the treatment of bacterial liver abscess should accord to different patient.