Ferreira João Pedro, Abreu Miguel Araújo, Rodrigues Patrícia, Carvalho Luísa, Correia João Araújo
Serviço de Medicina Interna, Hospital Santo António, CHP, Porto, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:399-406. Epub 2011 Dec 31.
Liver abscesses are a clinical entity difficult to diagnose and treat; therefore, a high index of suspicion is usually important. The majority of pyogenic liver abscesses are polymicrobial, with enteric and anaerobic bacteria being the most common. Staphylococcus aureus are found in around 7% of the liver abscesses, as reviewed in literature. This infection usually results from hematogenous dissemination of bacteria that's infecting some other organ. There are no published series on this matter, only case-reports.
In order to investigate the physiopathology, diagnosis and natural history of liver abscesses, namely those caused by methicillin-resistant Staphylococcus aureus (MRSA), we conducted a retrospective review by studying the clinical files of the patients diagnosed with liver abscess/portal pyemia between January of 2004 and December of 2009, with a total of 117 patients.
Fever and abdominal pain were the most common symptoms. Nearly all patients had a CT scan for diagnosis. Only 81.2% of patients had microbiological products collected. The most common pathogen isolated was Escherichia coli. MRSA was isolated in 7.6% of abscesses. Percutaneous drainage combined with antibiotic therapy was the most frequent treatment used. All MRSA isolated were susceptible to trimethoprim-sulfamethoxazole and vancomycin. The underlying conditions most frequently found were biliary diseases, followed by recent abdominal surgery, which in turn was the most frequent predisponent condition in MRSA liver abscesses. The total mortality rate was 17.9%. One patient died in the group of abscesses caused by MRSA.
MRSA is an important pathogen in hospital-acquired infections and intraabdominal infections are no exception. We find the association with post abdominal surgery very important. These findings have remarkable implications in therapeutics, prognosis and investigation.
肝脓肿是一种临床诊断和治疗都较为困难的病症；因此，高度的怀疑指数通常很重要。大多数化脓性肝脓肿是多微生物感染，肠道菌和厌氧菌最为常见。如文献综述所述，约7%的肝脓肿中可发现金黄色葡萄球菌。这种感染通常是由感染其他器官的细菌经血行播散所致。关于此事尚无已发表的系列研究，仅有病例报告。
为了研究肝脓肿，即耐甲氧西林金黄色葡萄球菌（MRSA）所致肝脓肿的生理病理学、诊断及自然病程，我们通过研究2004年1月至2009年12月期间诊断为肝脓肿/门静脉脓毒症的患者临床档案进行了一项回顾性研究，共有117例患者。
发热和腹痛是最常见的症状。几乎所有患者都进行了CT扫描以辅助诊断。仅有81.2%的患者采集了微生物样本。分离出的最常见病原体是大肠埃希菌。7.6%的脓肿中分离出了MRSA。经皮引流联合抗生素治疗是最常用的治疗方法。所有分离出的MRSA对复方新诺明和万古霉素敏感。最常发现的基础疾病是胆道疾病，其次是近期腹部手术，而近期腹部手术又是MRSA肝脓肿最常见的易感因素。总死亡率为17.9%。1例患者死于由MRSA引起的脓肿组。
MRSA是医院获得性感染中的重要病原体，腹腔内感染也不例外。我们发现其与腹部手术后感染的关联非常重要。这些发现对治疗、预后及研究具有显著意义。
