Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco La Ballena s/n, 35012, Las Palmas, Spain.
Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
Ir J Med Sci. 2020 Feb;189(1):155-161. doi: 10.1007/s11845-019-02041-4. Epub 2019 May 29.
In western countries, there has been a gradual shift from Escherichia coli to Klebsiella pneumoniae as an emerging pathogen isolated from pyogenic liver abscesses (PLA).
To compare outcomes between patients with Escherichia coli liver abscesses and non-Escherichia coli liver abscesses in terms of mortality.
One hundred nine-three consecutive hospital admissions of Pyogenic liver abscesses were analyzed, mean age 66.9 years old (± 13.6), 112 men (58%). The sample was divided into two groups: E. coli liver abscesses and non-E. coli liver abscesses. The etiologic, clinical, and microbiologic characteristics; therapeutic options; and outcomes, in terms of morbidity and mortality, between E. coli and non-E. coli liver abscesses were compared. In-hospital mortality, as outcome variable, was analyzed in a multivariate analysis.
Fifty-seven episodes of PLA (29.5%) corresponded to E. coli infections, and 136 (70.5%) to non-E. coli infections. Patients with E. coli PLA were more likely to have jaundice, polymicrobial isolation (57.1% vs 21.6%, p < 0.001), biliary origin (71.9% vs 39%, p < 0.001), and septic shock (38.6% vs 12.5%, p < 0.001). Antibiotic therapy alone, without percutaneous drainage, was less common in the E. coli PLA group (5.3% vs 18.4%, p = 0.018). These patients also showed a higher mortality (28.1% vs 11%, p = 0.003). In multivariate analysis, E. coli isolation PLA adjusted remained as an independent factor of mortality (OR 2.6, 95%CI 1.04-6.56, p = 0.041).
E. coli liver abscess may preclude a worse outcome than other microbiological agents, including the development of septic shock and mortality. Aggressive management must be considered.
在西方国家，从化脓性肝脓肿中分离出的新兴病原体已逐渐由大肠埃希菌转为肺炎克雷伯菌。
比较大肠埃希菌肝脓肿与非大肠埃希菌肝脓肿患者在死亡率方面的预后。
分析了 109 例连续住院的化脓性肝脓肿患者，平均年龄 66.9±13.6 岁，男性 112 例（58%）。将样本分为两组：大肠埃希菌肝脓肿和非大肠埃希菌肝脓肿。比较了大肠埃希菌和非大肠埃希菌肝脓肿的病因、临床和微生物学特征；治疗选择；以及发病率和死亡率方面的预后。将院内死亡率作为结局变量进行多变量分析。
57 例（29.5%）肝脓肿为大肠埃希菌感染，136 例（70.5%）为非大肠埃希菌感染。大肠埃希菌肝脓肿患者更易出现黄疸、混合微生物分离（57.1% vs 21.6%，p<0.001）、胆道来源（71.9% vs 39%，p<0.001）和感染性休克（38.6% vs 12.5%，p<0.001）。单独使用抗生素治疗，而不进行经皮引流，在大肠埃希菌肝脓肿组中较少见（5.3% vs 18.4%，p=0.018）。这些患者的死亡率也更高（28.1% vs 11%，p=0.003）。多变量分析显示，调整后的大肠埃希菌分离物仍然是死亡率的独立因素（OR 2.6，95%CI 1.04-6.56，p=0.041）。
与其他微生物病原体（包括感染性休克和死亡率的发展）相比，大肠埃希菌肝脓肿可能导致更差的预后。必须考虑积极的治疗方法。
