化脓性肝脓肿：大肠杆菌导致的不良后果是否比肺炎克雷伯菌更多？

Pyogenic Liver Abscess: Does Escherichia Coli Cause more Adverse Outcomes than Klebsiella Pneumoniae?

作者信息

Shelat Vishal G, Chia Clement L K, Yeo Charleen S W, Qiao Wang, Woon Winston, Junnarkar Sameer P

机构信息

Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore,

出版信息

World J Surg. 2015 Oct;39(10):2535-42. doi: 10.1007/s00268-015-3126-1.

DOI:10.1007/s00268-015-3126-1

PMID:26133908

Abstract

BACKGROUND

This paper aims to demonstrate if Escherichia coli pyogenic liver abscess (ECPLA) results in adverse outcomes compared to Klebsiella pneumoniae PLA (KPPLA).

METHODS

A retrospective review of all patients admitted at a tertiary hospital in Singapore from 2003 to 2011 was performed. Patients with age <18 years, amoebic liver abscess, infected liver cyst, culture negative abscess or ruptured liver abscess requiring urgent surgical intervention were excluded. Only patients with blood or pus culture confirmation of ECPLA (n = 24) or KPPLA (n = 264) were included. Median length of hospital stay, failure of non-operative therapy and 30-day mortality are the reported outcomes.

RESULTS

ECPLA affects older patients (68 vs. 62 years, p = 0.049). Ischemic heart disease was more common in ECPLA (29 vs. 14 %, p = 0.048) and there was no difference in diabetic state (42 vs. 38 %, p = 0.743). ECPLA is more commonly associated with hyperbilirubinemia (60 vs. 34 µmol/L, p = 0.003), increased gamma-glutamyl transpeptidase (236 vs. 16 IU/L, p = 0.038) and gallstones (58 vs. 30 %, p = 0.004). KPPLA are larger in size (6 vs. 4 cm, p = 0.006) and had percutaneous drainage (PD) more frequently (64 vs. 42 %, p = 0.034). There was no difference in median hospital stay (14 vs. 14 days, p = 0.110) or 30-day mortality (17 vs. 10 %, p = 0.307) between ECPLA and KPPLA. Among patients with ECPLA, antibiotic treatment with PD appeared to have higher mortality compared to antibiotic treatment alone (30 vs. 7 %) but this was not significant (p = 0.272).

CONCLUSION

In the setting of multimodal care, outcomes of ECPLA are comparable to KPPLA.

摘要

背景

本文旨在证明与肺炎克雷伯菌所致肝脓肿（KPPLA）相比，大肠埃希菌所致化脓性肝脓肿（ECPLA）是否会导致不良后果。

方法

对2003年至2011年在新加坡一家三级医院住院的所有患者进行回顾性研究。排除年龄<18岁、阿米巴肝脓肿、感染性肝囊肿、培养阴性脓肿或需要紧急手术干预的破裂性肝脓肿患者。仅纳入血培养或脓液培养确诊为ECPLA（n = 24）或KPPLA（n = 264）的患者。报告的结局指标为中位住院时间、非手术治疗失败率和30天死亡率。

结果

ECPLA患者年龄较大（68岁对62岁，p = 0.049）。缺血性心脏病在ECPLA患者中更常见（29%对14%，p = 0.048），糖尿病状态无差异（42%对38%，p = 0.743）。ECPLA更常伴有高胆红素血症（60 μmol/L对34 μmol/L，p = 0.003）、γ-谷氨酰转肽酶升高（236 IU/L对16 IU/L，p = 0.038）和胆结石（58%对30%，p = 0.004）。KPPLA脓肿更大（6 cm对4 cm，p = 0.006），更常接受经皮引流（PD）（64%对42%，p = 0.034）。ECPLA和KPPLA的中位住院时间（14天对14天，p = 0.110）或30天死亡率（17%对10%，p = 0.307）无差异。在ECPLA患者中，与单纯抗生素治疗相比，抗生素联合PD治疗的死亡率似乎更高（30%对7%），但差异无统计学意义（p = 0.272）。