Kim Hyun Ah, Chung Doo Ryeon, Yeom Joon-Sup, Ki Hyun Kyun, Cheong Hae Suk, Son Jun Seong, Lee Jin Seo, Moon Soo-Youn, Lee Seung Soon, Lee Jeong-A, Park Kyung-Hwa, Kang Seung-Ji, Jung Sook-In, Kim Shin-Woo, Chang Hyun Ha, Ryu Seong Yeol, Kwon Ki Tae, Moon Chisook, Wi Yu Mi, Heo Sang Taek, Joung Mi Kyong, Kang Cheol-In, Peck Kyong Ran, Song Jae-Hoon
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Diagn Microbiol Infect Dis. 2015 Jan;81(1):60-5. doi: 10.1016/j.diagmicrobio.2014.10.002. Epub 2014 Oct 13.
Although most Klebsiella pneumoniae liver abscesses have been reported to be monomicrobial, clinical outcomes have not been compared between antimicrobial therapy with and without anti-anaerobic coverage. A propensity score-matched cohort study was conducted using the 731 cases of K. pneumoniae liver abscess. Clinical outcomes were compared between a group discontinuing anti-anaerobic agents after K. pneumoniae identification and a group continuing. A total of 170 cases were matched at a 1:1 ratio using their propensity to discontinue anti-anaerobic agents. The McNemar's test showed no difference in mortality rates (1.8% for discontinuation versus 2.3% for continuation; P = 1.00) or relapse (1.8% versus 2.9%; P = 0.73) between groups. Early discontinuation of anti-anaerobic agents had no association with treatment failure by means of the generalized estimating equation model (odds ratio 0.48; P = 0.14) and the Kaplan-Meier method (P = 0.85) in matched groups. Early discontinuation of anti-anaerobic agents does not affect the clinical outcomes of patients with K. pneumoniae liver abscess.
尽管大多数报道称肺炎克雷伯菌肝脓肿为单一微生物感染，但对于有无抗厌氧菌覆盖的抗菌治疗之间的临床结局尚未进行比较。我们利用731例肺炎克雷伯菌肝脓肿病例进行了一项倾向评分匹配队列研究。对肺炎克雷伯菌鉴定后停用抗厌氧菌药物的组和继续使用抗厌氧菌药物的组的临床结局进行了比较。利用停用抗厌氧菌药物的倾向以1:1的比例对总共170例病例进行了匹配。McNemar检验显示两组之间的死亡率（停用组为1.8%，继续使用组为2.3%；P = 1.00）或复发率（1.8%对2.9%；P = 0.73）没有差异。在匹配组中，通过广义估计方程模型（优势比0.48；P = 0.14）和Kaplan-Meier方法（P = 0.85），早期停用抗厌氧菌药物与治疗失败无关。早期停用抗厌氧菌药物不会影响肺炎克雷伯菌肝脓肿患者的临床结局。
