Chang S W, Yen D H, Fung C P, Liu C Y, Chen K K, Tiu C M, Wang L M, Lee C H
Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Oct;63(10):721-8.
The clinical characteristics of renal abscess caused by Klebsiella pneumoniae have not been previously reported in case-series studies. The purpose of this study is to demonstrate the clinical characteristics of K pneumoniae renal abscess for early diagnosis and to identify the clinical risk factors associating with poor prognosis.
We retrospectively reviewed the medical records of 24 patients with K pneumoniae renal abscess, from April, 1982 through February, 1998. The clinical presentations, including the demographic characteristics, predisposing disorders, initial signs and symptoms, laboratory test results, diagnostic radiology studies, therapeutic modalities and risk factors associated with mortality were studied.
The mean age was 58.7 years and the male to female ratio was 10:14. The most common predisposing factors were diabetes mellitus (58%), urolithiasis (25%) and immunosuppression (17%). Fever, chills and flank pain were the most common symptoms and signs, whereas pyuria, elevation of leukocyte count, glucose, blood urea nitrogen and creatinine were the common laboratory features. The distinct complications of K pneumoniae renal abscess were bacteremia in 13 (54%), emphysematous pyelonephritis in five (21%), and metastatic septic infection in three (12.5%). The cure rate was 52% (11/21) in patients treated with a combination of antibiotics and percutaneous drainage; however, six (35%) patients who survived required another surgical procedure for complete recovery. The overall mortality rate was 25%. The clinical factors of elderly age (>65 years) at presentation, lethargy, elevation of serum blood urea nitrogen and pulmonary complications were associated with poor prognoses.
Focusing on the early diagnosis of K pneumoniae renal abscess and recognition of the prognostic factors for a poor prognosis, we highlight the specific clinical characteristics that include elderly age, lethargy, impairment of renal function, metastatic septic lesions and pulmonary complications. All patients with K pneumoniae renal abscesses should receive empiric antibiotics and percutaneous drainage or aspiration, and surgical intervention as necessary for patients with intractable disease.
肺炎克雷伯菌引起的肾脓肿的临床特征此前尚未在病例系列研究中报道。本研究的目的是阐述肺炎克雷伯菌肾脓肿的临床特征以实现早期诊断，并确定与预后不良相关的临床危险因素。
我们回顾性分析了1982年4月至1998年2月期间24例肺炎克雷伯菌肾脓肿患者的病历。研究了临床表现，包括人口统计学特征、易感疾病、初始体征和症状、实验室检查结果、诊断性放射学检查、治疗方式以及与死亡率相关的危险因素。
平均年龄为58.7岁，男女比例为10:14。最常见的易感因素是糖尿病（58%）、尿路结石（25%）和免疫抑制（17%）。发热、寒战和胁腹痛是最常见的症状和体征，而脓尿、白细胞计数升高、血糖、血尿素氮和肌酐升高是常见的实验室特征。肺炎克雷伯菌肾脓肿的明显并发症包括13例（54%）菌血症、5例（21%）气肿性肾盂肾炎和3例（12.5%）转移性脓毒症感染。联合使用抗生素和经皮引流治疗的患者治愈率为52%（11/21）；然而，6例（35%）存活患者需要再次进行手术以完全康复。总死亡率为25%。就诊时年龄较大（>65岁）、嗜睡、血清血尿素氮升高和肺部并发症等临床因素与预后不良相关。
关注肺炎克雷伯菌肾脓肿的早期诊断和预后不良的预后因素，我们强调了包括老年、嗜睡、肾功能损害、转移性脓毒症病变和肺部并发症在内的特定临床特征。所有肺炎克雷伯菌肾脓肿患者均应接受经验性抗生素治疗和经皮引流或抽吸，对于难治性疾病患者必要时进行手术干预。
