Rodriguez-Villar S, Fife A, Baldwin C, Warne R R
Critical Care Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
Microbiology Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
Oxf Med Case Reports. 2019 May 31;2019(5):omz032. doi: 10.1093/omcr/omz032. eCollection 2019 May.
We report a case of a patient with fatal community-acquired pyogenic liver abscess (CA-PLA) caused by multi drug-resistant, hypervirulent, (mdrhvKP). HvKP causing PLA has been described in East and South East Asia and it is recognized as an emerging infection worldwide. The syndrome is characterized by cryptogenic liver abscess formation without a previous history of hepatobiliary or colonic disease and metastatic spread of infection via the bloodstream to distant sites, including lungs, central nervous system and other organ systems. Diabetes mellitus is a recognized risk factor. Most previously reported cases have involved antibiotic susceptible strains of hvKP although reports of bloodstream infections caused by resistant strains, including carbapenemase producers, are increasing. Our report highlights the need for awareness of this devastating infection in patients presenting with sepsis and liver abscess without underlying hepatobiliary or colonic disease.
我们报告了一例由多重耐药、高毒力（mdrhvKP）引起的致命性社区获得性化脓性肝脓肿（CA-PLA）患者。在东亚和东南亚地区已报道了由高毒力肺炎克雷伯菌（HvKP）引起的化脓性肝脓肿，并且它在全球范围内被认为是一种新发感染。该综合征的特征是在没有先前肝胆或结肠疾病史的情况下形成隐源性肝脓肿，以及感染通过血流转移至远处部位，包括肺、中枢神经系统和其他器官系统。糖尿病是公认的危险因素。尽管由耐药菌株（包括产碳青霉烯酶菌株）引起的血流感染报告在增加，但之前报道的大多数病例涉及对抗生素敏感的HvKP菌株。我们的报告强调，对于没有潜在肝胆或结肠疾病而出现败血症和肝脓肿的患者，需要提高对这种毁灭性感染的认识。
