Department of Laboratory Medicine, National University Hospital System, 5 Lower Kent Ridge Road, 119074, Singapore.
Int J Infect Dis. 2013 Mar;17(3):e185-8. doi: 10.1016/j.ijid.2012.10.002. Epub 2012 Nov 13.
Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment.
We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality.
All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02).
The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.
社区获得性肺炎克雷伯菌已成为亚洲肝脓肿的主要病因。我们采用标准化方案，对 2005 年至 2011 年在新加坡两家门诊肠外抗菌治疗（OPAT）中心治疗的所有肺炎克雷伯菌肝脓肿病例进行了前瞻性队列研究，以评估治疗的安全性和疗效。
我们纳入了所有符合 OPAT 条件的患者，这些患者的肝脓肿经影像学（计算机断层扫描或超声）证实，且从脓肿液和/或血液中获得了肺炎克雷伯菌阳性的微生物培养结果。在两所大学教学医院进行。研究的终点为治愈、临床反应、再入院和死亡率。
研究纳入的 109 例患者均成功完成 OPAT 治疗。由于临床恶化，9 例患者需要短期再次入院。抗生素停药后 30 天内无死亡或复发。脓肿大小大于 5cm 与临床反应延迟相关（优势比 5.34，95%置信区间 1.25-22.91，p=0.02）。
采用标准化方案通过 OPAT 治疗肺炎克雷伯菌肝脓肿是一种安全有效的替代方法，可替代住院静脉内使用抗生素。
