Clinical Characteristics of 606 Patients with Community-Acquired Pyogenic Liver Abscess: A Six-Year Research in Yantai

Abstract

Objective This study was designed to analyze the clinical characteristics, etiological characteristics, drug resistance, and empirical use of antibiotics for community-acquired pyogenic liver abscess (PLA) to provide a basis for rational and effective empirical treatment of PLA in the local area. Methods The clinical data, etiological characteristics, drug resistance, and empirical anti-infective therapy schemes of 606 patients with PLA were collected and analyzed retrospectively. Results The included patients were mainly males, with a male-to-female ratio of 1.3:1. The average age of the patients was 60.3 ± 14.1 years. The underlying diseases were diabetes and biliary tract disease, accounting for 38.7% and 22.3%, respectively. The main clinical manifestations were fever (92.9%), abdominal pain (44.7%), and nausea (33.3%). Imaging findings: the proportion of patients with a single lesion was 74.7%, and 67% of the patients had involvement in the right lobe of the liver. The main pathogen was Klebsiella pneumoniae accounted for 74.9% in blood culture and 84.1% in pus culture, mainly extended-spectrum β-lactamase. In 272 strains negative for extended-spectrum β-lactamase (ESBLs), 100% were resistant to ampicillin and less than 50% were sensitive to nitrofurantoin. Only 36 ESBL-positive strains had higher than 80% sensitivity to carbapenems, β-lactamase inhibitor compound, and amikacin. Patients treated with different treatment methods showed significantly different average length of hospital stay (14 [9–21] vs 13 [8–18]). Empirical anti-infective therapy: Beta-lactamase complex, carbapenems, cephalosporins, and quinolones were used in 280 (37.6%), 180 (29.7%), 180 (29.7%), and 147 (24.3%) patients, respectively. Conclusion Patients with community-acquired PLA in this area are mainly males, and the underlying diseases are mainly diabetes and hepatobiliary system disease. The main clinical manifestation is fever, so patients with fever of unknown cause should pay attention to possible liver abscesses. Based on drug sensitivity tests, the empirical use of antibiotics is somewhat unreasonable.

A retrospective study of pyogenic liver abscess concentrating on the relationship between strain and the location of the intrahepatic abscess

“…[18] It has been mentioned in the literature that KP is naturally resistant to ampicillin, with 100% susceptibility. [17] In our study, the drug resistance rate of the most common cultures of PLA were as follows: KP to ampicillin (78.1%), E. coli (64%), OGNB (68.8%), and Enterococcus (46.2%). Therefore, ampicillin is not suitable for rst-line drug use in the Zhejiang region.…”

“…[16]KP is sensitive to most antibiotics except ampicillin (78.1%), which is slightly different from a previous report showing that KP was resistant to ampicillin in all cases (100%). [17] OGNB had a high drug resistance rate to β-lactam antibiotics and quinolones, and carbapenems or tetracycline antibiotics were selected according to the situation when the drug sensitivity results were available. The drug resistance rate of Enterococcus strains to β-lactams, quinolones and tetracyclines is high.…”

Alterations of Gut Microbiota in Pyogenic Liver Abscess Patients with and without Type 2 Diabetes Mellitus

“…1,2 In recent years, there has been a noticeable rise in the incidence rate of PLA in adults in China and Korea. [3][4][5] The incidence of liver abscesses is also on the rise among children in the United States. 6 Patients with PLA do not typically present with specific symptoms.…”