Chen Yuanwen, Zhou Yisheng, Xu Zhibin
Department of Burn and Plastic Surgery, The People's Hospital of Baoan Shenzhen, Shenzhen, Guangdong 518101, China.
Department of Cardiology, Guangzhou Development District Hospital (Guangzhou Huangpu District People's Hospital), Guangdong 510730, China.
IDCases. 2024 Nov 13;38:e02117. doi: 10.1016/j.idcr.2024.e02117. eCollection 2024.
Investigating the clinical characteristics and treatment strategies of pyogenic liver abscess (PLA) complicated by infective endocarditis (IE), this study draws on a successfully treated case of PLA caused by Klebsiella pneumoniae, alongside a literature review of similar cases.
We report a 50-year-old male with type 2 diabetes who presented with acute fever, chills, and a liver abscess. The patient was initially treated with intravenous ceftriaxone (2 g daily). Due to the onset of septic shock, the antibiotic regimen was escalated to piperacillin-tazobactam (4.5 g every 8 h) and levofloxacin (0.5 g daily). Ultrasound-guided percutaneous drainage of the liver abscess was performed, and blood cultures confirmed . Upon the development of infective endocarditis, the treatment was adjusted to a combination of ceftriaxone and amikacin for one week, followed by six weeks of ceftriaxone monotherapy, resulting in full recovery.
This case report illustrates the rare association of Klebsiella pneumoniae-induced PLA with IE in a diabetic patient. It emphasizes the importance of individualized treatment strategies, with insights drawn from this case contributing to the understanding of managing such complex infections. While the successful outcome of this case provides valuable clinical insights, it highlights the need for careful consideration in treatment approaches. The findings from this single case should guide clinicians in similar scenarios but should not be generalized without further evidence.
本研究通过对一例由肺炎克雷伯菌引起的化脓性肝脓肿（PLA）成功治疗病例进行分析，并结合类似病例的文献综述，探讨PLA合并感染性心内膜炎（IE）的临床特征及治疗策略。
我们报告了一名50岁的2型糖尿病男性患者，其出现急性发热、寒战及肝脓肿。患者最初接受静脉注射头孢曲松（每日2g）治疗。由于发生感染性休克，抗生素治疗方案升级为哌拉西林-他唑巴坦（每8小时4.5g）和左氧氟沙星（每日0.5g）。对肝脓肿进行了超声引导下经皮引流，血培养确诊。在感染性心内膜炎发生后，治疗调整为头孢曲松和阿米卡星联合治疗1周，随后头孢曲松单药治疗6周，患者完全康复。
本病例报告说明了糖尿病患者中肺炎克雷伯菌引起的PLA与IE的罕见关联。强调了个体化治疗策略的重要性，从该病例中获得的见解有助于理解此类复杂感染的管理。虽然该病例的成功结果提供了有价值的临床见解，但突出了治疗方法需谨慎考虑。这一单个病例的发现应指导临床医生处理类似情况，但在没有进一步证据的情况下不应推广。
