Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Institute of Gastroenterology, Zhejiang University, Hangzhou, China.
Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China.
Sci Rep. 2016 Dec 8;6:38587. doi: 10.1038/srep38587.
Pyogenic liver abscess (PLA) is a common intra-abdominal infection in adults. In this study, we aim to explore demographic and clinical characteristics of PLA focusing on Klebsiella pneumoniae (K. pneumoniae) induced PLA (KP-PLA) in mainland China. A retrospective review of medical records from all patients with KP-PLA admitted to a tertiary teaching hospital over a 21-year period (1994-2015) was performed. Among 296 PLA cases with confirmed culture-positive data, K. pneumoniae was revealed as the predominant pathogen (n = 189, 63.9%), followed by Escherichia coli (n = 39, 13.2%). Strikingly, KP-PLA patients had a higher incidence of metabolic disorders, such as diabetes mellitus (49.7% vs. 36.4%, P = 0.027; odds ratio (OR): 1.725; 95% confidence interval (CI): 1.061-2.805), hypertension (38.1% vs. 19.6%, P = 0.001; OR: 2.520; 95% CI: 1.439-4.413), and fatty liver (32.3% vs. 14.0%, P = 0.001; OR: 2.923; 95% CI: 1.564-5.462) than those with non-K. pneumoniae induced PLA (non-KP-PLA). Moreover, patients with KP-PLA had higher susceptibility to septic metastatic infection at distant sites compared to those with non-KP-PLA (10.6% vs. 3.7%, p = 0.038). Our results indicate that K. pneumoniae is the predominant pathogen of PLA in mainland China. KP-PLA is frequently diagnosed in patients with metabolic diseases and has a higher risk for septic metastatic infection.
细菌性肝脓肿（PLA）是成人常见的腹腔内感染。本研究旨在探讨 PLA 的人口统计学和临床特征，重点关注中国大陆地区肺炎克雷伯菌（K. pneumoniae）引起的 PLA（KP-PLA）。对一家三级教学医院 21 年来（1994-2015 年）所有确诊为 KP-PLA 的患者的病历进行回顾性分析。在 296 例 PLA 病例中，有明确培养阳性数据的患者中，肺炎克雷伯菌是主要病原体（n=189，63.9%），其次是大肠杆菌（n=39，13.2%）。值得注意的是，KP-PLA 患者代谢紊乱的发生率更高，如糖尿病（49.7%比 36.4%，P=0.027；比值比（OR）：1.725；95%置信区间（CI）：1.061-2.805）、高血压（38.1%比 19.6%，P=0.001；OR：2.520；95%CI：1.439-4.413）和脂肪肝（32.3%比 14.0%，P=0.001；OR：2.923；95%CI：1.564-5.462）比非肺炎克雷伯菌引起的 PLA（非 KP-PLA）患者更高。此外，与非 KP-PLA 患者相比，KP-PLA 患者发生远处部位感染转移性脓肿的风险更高（10.6%比 3.7%，p=0.038）。我们的研究结果表明，肺炎克雷伯菌是中国大陆地区 PLA 的主要病原体。KP-PLA 常发生在代谢性疾病患者中，且发生感染转移性脓肿的风险更高。
