Pérez-Escobar Juanita, Ramirez-Quesada Wagner, Calle-Rodas Daniel Alejandro, Chi-Cervera Luis Alberto, Navarro-Alvarez Nalu, Aquino-Matus Jorge, Ramírez-Hinojosa Juan Pablo, Moctezuma-Velázquez Carlos, Torre Aldo
Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
Department of Internal Medicine, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico.
World J Hepatol. 2020 Oct 27;12(10):816-828. doi: 10.4254/wjh.v12.i10.816.
Pyogenic liver abscess (PLA) is a rare disease with an estimated incidence that varies widely across the globe, being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada. Even though there are multiple microorganisms capable of producing an abscess in the liver, including , fungi, and viruses, most abscesses are derived from bacterial infections. The epidemiology of PLA in Mexico is currently unknown.
To describe the clinical, demographic and microbiologic characteristics of PLA in Mexico.
This is a retrospective study carried out in two centers, and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess. We collected demographic, clinical, and microbiological information, treatment, complications, and outcomes. A logistic regression analysis was used to determine the association between different variables and mortality rates.
A total of 345 patients were included in this study. 233 (67.5%) had confirmed PLA, 133 (30%) patients had no positive culture and negative serology and 9 (2.5%) had mixed abscesses. The mean age was 50 years (ranging from 16-97 years) and 63% were female. 65% of the patients had positive cultures for Extended Spectrum Beta-Lactamases (ESBL)- and . Cefotaxime was administered in 60% of cases. The most common sources of infection were ascending cholangitis and cholecystitis in 34 (10%) and 31 (9%), respectively. The median length of hospital stay was 14 d. 165 patients underwent percutaneous catheter drainage. The inpatient mortality rate was 63%. Immunocompromised state [OR 3.9, 95%CI: 1.42-10.46], ESBL- [OR 6.7, 95%CI: 2.7-16.2] and [OR 4-8, 95%CI: 1.6-14.4] predicted inpatient mortality by multivariate analysis.
The prevalence of PLA is increasing in Mexico and has a very high mortality rate. ESBL- and are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
化脓性肝脓肿（PLA）是一种罕见疾病，全球估计发病率差异很大，在台湾高达115.4/10万居民，在欧洲和加拿大低至1.1 - 1.2/10万居民。尽管有多种微生物可在肝脏产生脓肿，包括真菌和病毒，但大多数脓肿源自细菌感染。墨西哥PLA的流行病学目前尚不清楚。
描述墨西哥PLA的临床、人口统计学和微生物学特征。
这是一项在两个中心进行的回顾性研究，纳入2006年至2018年间诊断为化脓性脓肿的患者。我们收集了人口统计学、临床和微生物学信息、治疗、并发症及结局。采用逻辑回归分析确定不同变量与死亡率之间的关联。
本研究共纳入345例患者。233例（67.5%）确诊为PLA，133例（30%）患者培养阴性且血清学阴性，9例（2.5%）为混合性脓肿。平均年龄为50岁（范围16 - 97岁），63%为女性。65%的患者超广谱β-内酰胺酶（ESBL）和……培养阳性。60%的病例使用了头孢噻肟。最常见的感染源分别是上行性胆管炎和胆囊炎，各占34例（10%）和31例（9%）住院时间中位数为14天。165例患者接受了经皮导管引流。住院死亡率为63%。多因素分析显示免疫功能低下状态[比值比（OR）3.9，95%置信区间（CI）：1.42 - 10.46]、ESBL……[OR 6.7，95%CI：2.7 - 16.2]和……[OR 4.8，95%CI：1.6 - 14.4]可预测住院死亡率。
墨西哥PLA的患病率在上升，死亡率很高。ESBL和……是导致PLA最常见的微生物，是住院死亡率的独立预测因素。
