Myeong Jun-Ho, Kyoung Dae-Sung, Park Min-Ae, Kim Sang Gyune, Kim Young Seok, Yoo Jeong-Ju, Kim Min Jae
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
Data Science Team, Hanmi Pharm. Co. Ltd., Seoul, Republic of Korea.
J Infect Public Health. 2022 Apr;15(4):425-432. doi: 10.1016/j.jiph.2022.03.003. Epub 2022 Mar 15.
Gram-negative bacteria such as Klebsiella pneumoniae and Escherichia coli are the most common cause of pyogenic liver abscess (PLA). We investigated whether the use of anaerobic-covering antibiotics is essential for the treatment of pyogenic liver abscess.
We analyzed the Health Insurance Review and Assessment Service data in Korea between 2007 and 2017. We classified PLA into two groups: a group using antibiotics that inhibited only aerobic strains (anaerobe (-) group) and a group using antibiotics that inhibited both aerobic and anaerobic strains (anaerobe (+) group). The primary outcome was the difference in in-hospital mortality between the two groups.
During this period, a total of 30,690 PLA patients were obtained. There were 6733 patients in the anaerobe (-) group and 23,957 patients in the anaerobe (+) group. In-hospital mortality was significantly lower in the anaerobe (+) group than the anaerobe (-) group (7.9% vs. 15.6%, p < 0.001). In multivariate analysis, the use of anaerobic antibiotics reduced the in-hospital mortality by 42% (odds ratio 0.42, 95% confidence interval 0.38-0.46, p < 0.001) after adjusting for age and comorbidities. Furthermore, the improvement of in-hospital mortality was present regardless of the presence of cancer or diabetes.
The use of broad-spectrum empirical antibiotics covering anaerobic strains is important for the treatment of pyogenic liver abscess.
肺炎克雷伯菌和大肠杆菌等革兰氏阴性菌是化脓性肝脓肿（PLA）最常见的病因。我们调查了使用覆盖厌氧菌的抗生素对化脓性肝脓肿治疗是否必不可少。
我们分析了2007年至2017年韩国健康保险审查与评估服务的数据。我们将PLA分为两组：一组使用仅抑制需氧菌的抗生素（厌氧菌（-）组）和一组使用抑制需氧菌和厌氧菌的抗生素（厌氧菌（+）组）。主要结局是两组之间的住院死亡率差异。
在此期间，共获得30690例PLA患者。厌氧菌（-）组有6733例患者，厌氧菌（+）组有23957例患者。厌氧菌（+）组的住院死亡率显著低于厌氧菌（-）组（7.9%对15.6%，p<0.001）。在多变量分析中，在调整年龄和合并症后，使用厌氧抗生素使住院死亡率降低了42%（比值比0.42，95%置信区间0.38 - 0.46，p<0.001）。此外，无论是否存在癌症或糖尿病，住院死亡率均有改善。
使用覆盖厌氧菌株的广谱经验性抗生素对化脓性肝脓肿的治疗很重要。
