Park Ji-Won, Kim Jung-Hee, Jung Jang-Han, Kim Sung-Eun, Kim Hyoung-Su, Jeong Haemin, Suk Ki Tae, Jang Myoung-Kuk, Kim Dong-Joon, Lee Myung-Seok, Park Sang-Hoon
Department of Internal Medicine, Hallym University Sacred Heart Hospital of Hallym University Medical Center, 22, Gwanpyeong-ro 170 Beon-gil, Anyang-si 14068, Korea.
Institute for Liver and Digestive Diseases, Hallym University, Chuncheon-si 24252, Korea.
J Clin Med. 2022 Feb 19;11(4):1114. doi: 10.3390/jcm11041114.
The emergence of multidrug-resistant organisms (MDROs) is a growing problem worldwide. However, little is known about the incidence, clinical features and outcomes of pyogenic liver abscesses (PLAs) caused by MDROs. A retrospective study of 833 patients with PLA admitted from 2008 to 2017 was performed. MDROs were found in 55 (6.6%) patients, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was the most common causative microorganism. To evaluate the clinical features of and risk factors for MDRO-induced PLAs, propensity score matching (PSM) was performed in a 1:3 ratio (55 patients with MDROs and 165 patients without MDROs). After PSM, previous hepatobiliary procedure, preadmission exposure to antibiotics and elevated alkaline phosphatase levels were independent risk factors for MDRO-induced PLA. Sixteen patients (7.3%) died during hospitalization. Admission to intensive care unit (ICU), inadequate initial antibiotic treatment and use of inotropic agents were factors predictive of mortality. Although the presence of MDROs was not associated with in-hospital mortality, inadequate initial antibiotic treatment was prescribed to a large portion of the patients with MDRO-induced PLAs. We conclude that initial empirical antibiotic therapy for PLA should be based on the possibility of infection with MDROs, and close monitoring is necessary for patients with risk factors for in-hospital mortality.
多重耐药菌（MDROs）的出现是一个在全球范围内日益严重的问题。然而，对于由MDROs引起的化脓性肝脓肿（PLAs）的发病率、临床特征和转归，人们了解甚少。我们对2008年至2017年收治的833例PLA患者进行了一项回顾性研究。在55例（6.6%）患者中发现了MDROs，产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌是最常见的致病微生物。为了评估MDROs所致PLAs的临床特征和危险因素，我们以1:3的比例（55例MDROs感染患者和165例非MDROs感染患者）进行了倾向评分匹配（PSM）。PSM后，既往肝胆手术史、入院前使用抗生素和碱性磷酸酶水平升高是MDROs所致PLA的独立危险因素。16例（7.3%）患者在住院期间死亡。入住重症监护病房（ICU）、初始抗生素治疗不充分和使用血管活性药物是死亡的预测因素。虽然MDROs的存在与院内死亡率无关，但很大一部分MDROs所致PLAs患者的初始抗生素治疗并不充分。我们得出结论，PLA的初始经验性抗生素治疗应基于MDROs感染的可能性，对于有院内死亡危险因素的患者，密切监测是必要的。
