Gupta Ayushya, Thakur Nancy, Chaudhary Ashish K, Patel Udit
Department of General Surgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND.
Department of Anatomy, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND.
Cureus. 2024 Dec 10;16(12):e75454. doi: 10.7759/cureus.75454. eCollection 2024 Dec.
Purpose Hepatic abscesses remain a significant clinical challenge due to high morbidity and mortality. This research aims to examine the etiological spectrum, management approaches, clinical features, and results in hepatic abscesses in a tertiary care facility in northern India, emphasizing the distinctions among pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs). Methods This retrospective study was done at GSVM Medical College, Kanpur, analyzing 725 patients with hepatic abscesses over a 10-year period. Patients were included based on confirmed diagnoses of ALAs or PLAs through clinical, serological, and microbiological evidence. Data on demographics, clinical presentation, imaging findings, laboratory results, and management approaches were extracted from hospital records. IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States) was employed for statistical analysis, and continuous variables were displayed accordingly as means or medians and categorical variables as frequencies. Subgroup analyses were conducted based on abscess characteristics, including size, location, and etiology. Results Of the 725 patients analyzed, the mean age was 42.7 ± 15.8 years, with men comprising 85.93% of the cohort. ALAs accounted for 82.3% of cases, while PLAs comprised 12%. PLA cases frequently involved Gram-negative pathogens, such as Escherichia coli and Klebsiella pneumoniae, with 64% of PLA patients exhibiting positive pus or blood cultures. Common presenting symptoms included abdominal pain (87%) and fever (84.5%). Significant comorbidities included alcoholism (43.6%) and diabetes mellitus (34.2%). Right lobe involvement was predominant (75.9%), and multiple abscesses were noted in 47.5% of patients. Complications included pleural effusion (53.9%), abscess rupture (16.3%), and systemic inflammatory response syndrome (25.7%). Management strategies comprised antibiotics, percutaneous catheter drainage (74.8%), and needle aspiration (43.4%), with conservative treatment being effective in smaller abscesses. Mortality rates were low, at 1.6% for ALAs and 1.5% for PLAs. Hospital stays were shorter for PLA cases (median: five days) compared to ALAs (median: 7.3 days). Conclusion This study underscores the predominance of ALAs in endemic regions like India and highlights the significant role of Gram-negative bacteria in PLAs. Tailored management strategies, including percutaneous interventions and early antibiotic therapy, were associated with favorable outcomes and low mortality. However, the emergence of antimicrobial resistance in PLAs warrants robust antimicrobial stewardship. Public health measures focused on sanitation and clean water are critical to reducing the prevalence of ALAs.
目的 由于高发病率和死亡率，肝脓肿仍然是一个重大的临床挑战。本研究旨在调查印度北部一家三级医疗机构中肝脓肿的病因谱、管理方法、临床特征及结果，强调化脓性肝脓肿（PLA）和阿米巴肝脓肿（ALA）之间的区别。方法 这项回顾性研究在坎普尔的GSVM医学院进行，分析了10年间725例肝脓肿患者。根据临床、血清学和微生物学证据确诊为ALA或PLA的患者被纳入研究。从医院记录中提取有关人口统计学、临床表现、影像学检查结果、实验室检查结果及管理方法的数据。使用IBM SPSS Statistics for Windows 23版（2015年发布；IBM公司，美国纽约州阿蒙克）进行统计分析，连续变量相应地以均值或中位数表示，分类变量以频率表示。根据脓肿特征（包括大小、位置和病因）进行亚组分析。结果 在分析的725例患者中，平均年龄为42.7±15.8岁，男性占队列的85.93%。ALA占病例的82.3%，而PLA占12%。PLA病例常涉及革兰氏阴性病原体，如大肠杆菌和肺炎克雷伯菌，64%的PLA患者脓液或血培养呈阳性。常见的症状包括腹痛（87%）和发热（84.5%）。显著的合并症包括酗酒（43.6%）和糖尿病（34.2%）。右叶受累为主（75.9%），47.5%的患者有多个脓肿。并发症包括胸腔积液（53.9%）、脓肿破裂（16.3%）和全身炎症反应综合征（25.7%）。管理策略包括抗生素、经皮导管引流（74.8%）和穿刺抽吸（43.4%），保守治疗对较小的脓肿有效。死亡率较低，ALA为1.6%，PLA为1.5%。与ALA（中位数：7.3天）相比，PLA病例的住院时间较短（中位数：5天）。结论 本研究强调了ALA在印度等流行地区的优势，并突出了革兰氏阴性菌在PLA中的重要作用。包括经皮干预和早期抗生素治疗在内的定制管理策略与良好的结果和低死亡率相关。然而，PLA中抗菌药物耐药性的出现需要强有力的抗菌药物管理。注重环境卫生和清洁水的公共卫生措施对于降低ALA的患病率至关重要。
