Shelat Vishal G, Wang Qiao, Chia Clement Lk, Wang Zhongkai, Low Jee Keem, Woon Winston Wl
Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Hepatobiliary Pancreat Dis Int. 2016 Oct;15(5):504-511. doi: 10.1016/s1499-3872(16)60127-3.
Etiologic organism is not frequently isolated despite multiple blood and fluid cultures during management of pyogenic liver abscess (PLA). Such culture negative pyogenic liver abscess (CNPLA) is routinely managed by antibiotics targeted to Klebsiella pneumoniae. In this study, we evaluated the outcomes of such clinical practice.
All the patients with CNPLA and Klebsiella pneumoniae PLA (KPPLA) admitted from January 2003 to December 2011 were included in the study. A retrospective review of medical records was performed and demographic, clinical and outcome data were collected.
A total of 528 patients were treated as CNPLA or KPPLA over the study period. CNPLA presented more commonly with abdominal pain (P=0.024). KPPLA was more common in older age (P=0.029) and was associated with thrombocytopenia (P=0.001), elevated creatinine (P=0.002), bilirubin (P=0.001), alanine aminotransferase (P=0.006) and C-reactive protein level (P=0.036). CNPLA patients tend to have anemia (P=0.015) and smaller abscess (P=0.008). There was no difference in hospital stay (15.7 vs 16.8 days) or mortality (14.0% vs 11.0%). No patients required surgical drainage after initiation of medical therapy.
Despite demographic and clinical differences between CNPLA and KPPLA, overall outcomes are not different.
尽管在化脓性肝脓肿（PLA）的治疗过程中进行了多次血培养和体液培养，但致病微生物并不经常被分离出来。这种培养阴性的化脓性肝脓肿（CNPLA）通常采用针对肺炎克雷伯菌的抗生素进行治疗。在本研究中，我们评估了这种临床实践的结果。
纳入2003年1月至2011年12月期间收治的所有CNPLA和肺炎克雷伯菌肝脓肿（KPPLA）患者。对病历进行回顾性分析，收集人口统计学、临床和结局数据。
在研究期间，共有528例患者被诊断为CNPLA或KPPLA。CNPLA更常表现为腹痛（P = 0.024）。KPPLA在老年人中更常见（P = 0.029），并与血小板减少（P = 0.001）、肌酐升高（P = 0.002）、胆红素升高（P = 0.001）、丙氨酸转氨酶升高（P = 0.006）和C反应蛋白水平升高（P = 0.036）相关。CNPLA患者往往有贫血（P = 0.015）且脓肿较小（P = 0.008）。住院时间（15.7天对16.8天）或死亡率（14.0%对11.0%）没有差异。开始药物治疗后，没有患者需要手术引流。
尽管CNPLA和KPPLA在人口统计学和临床特征上存在差异，但总体结局并无不同。
