Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Ministry of Health Holdings, Singapore.
Surg Infect (Larchmt). 2020 Dec;21(10):884-890. doi: 10.1089/sur.2019.278. Epub 2020 Mar 27.
Gas-forming pyogenic liver abscess (GFPLA) occurs in 7%-24% of all PLAs and has been associated traditionally with high mortality rates. Studies have suggested that the use of a proactive approach of prompt resuscitation, parenteral antibiotic agents, percutaneous drainage, and a dedicated multi-disciplinary team may improve clinical outcomes. Hence, we aim to investigate whether the clinical outcomes of PLA are determined by gas formation. This is a retrospective study of patients with PLA from 2007 to 2011. A 1:2 propensity score matching (PSM) analysis was performed using age, co-morbid diabetes mellitus, presence of septic shock, hemoglobin levels, international normalized ratio, creatinine, total bilirubin, positive blood culture and pus culture, and the size of abscess. Baseline demographics, clinical profile, and peri-operative data were compared. There were 213 patients who had PLA: 41 (19.2%) patients had GFPLA and 172 (80.8%) patients had non-GFPLA. The PSM analysis resulted in a total of 108 patients (36 GFPLA and 72 non-GFPLA). Median duration of parenteral antibiotic agents was significantly lower in the GFPLA group (9.5 d vs. 14 d, p = 0.044), but median total duration of antibiotic use was comparable (GFPLA 39 d vs. non-GFPLA 37 d, p = 0.634). Median length of stay (days) did not differ significantly between GFPLA and non-GFPLA (14 vs. 15, p = 0.299). There were no statistically significant differences between GFLPA and non-GFLPA in the need for percutaneous drainage (26/36 (72.2%) vs. 47/72 (65.3%), respectively, p = 0.467) and in-hospital all-cause death (4/36 (11.1%) vs. 7 (9.7%), p = 0.822) Outcomes of GFPLA are comparable to those of non-GFPLA in the era of multi-modal care.
产气性化脓性肝脓肿（GFPLA）占所有 PLA 的 7%-24%，传统上与高死亡率相关。研究表明，采用积极的复苏、静脉内抗生素、经皮引流和专门的多学科团队的方法可能会改善临床结果。因此，我们旨在研究 PLA 的临床结果是否取决于气体形成。这是一项对 2007 年至 2011 年 PLA 患者的回顾性研究。使用年龄、合并糖尿病、脓毒性休克、血红蛋白水平、国际标准化比值、肌酐、总胆红素、阳性血培养和脓液培养以及脓肿大小进行 1:2 倾向评分匹配（PSM）分析。比较了基线人口统计学、临床特征和围手术期数据。共有 213 例 PLA 患者：41 例（19.2%）患者为 GFPLA，172 例（80.8%）患者为非-GFPLA。PSM 分析共纳入 108 例患者（36 例 GFPLA 和 72 例非-GFPLA）。GFPLA 组的静脉内抗生素使用时间中位数明显较短（9.5 天比 14 天，p=0.044），但抗生素总使用时间中位数相似（GFPLA 39 天比非-GFPLA 37 天，p=0.634）。GFPLA 和非-GFPLA 的住院时间中位数无显著差异（14 天比 15 天，p=0.299）。GFPLA 和非-GFPLA 之间经皮引流的需求（分别为 26/36（72.2%）和 47/72（65.3%），p=0.467）和院内全因死亡率（分别为 4/36（11.1%）和 7（9.7%），p=0.822）无统计学差异。在多模式治疗时代，GFPLA 的结果与非-GFPLA 相当。
