肺炎克雷伯菌肝脓肿70例临床分析  

Clinical characteristics of 70 cases of Klebsiella pneumoniae liver abscess

作　　者：吴柳 张洁[1] 孙琳[1] 樊琴[1] 张文宏 邵凌云 

机构地区：[1]上海中医药大学附属普陀医院感染科,上海200062 [2]复旦大学附属华山医院感染病科

出　　处：《中国感染与化疗杂志》2018年第1期11-17,共7页Chinese Journal of Infection and Chemotherapy

基　　金：普陀区临床重点专科;普陀区卫计委(院内编号:2016PTZK09)

摘　　要：目的总结肺炎克雷伯菌肝脓肿的临床特征和治疗经验,提高诊疗水平。方法回顾性分析上海2所三级医院2013年1月-2016年3月收治的323例肝脓肿的临床资料。结果 323例细菌性肝脓肿,细菌培养70例为肺炎克雷伯菌。肝脓肿肺炎克雷伯菌组(KP组)与非肺炎克雷伯菌组(nKP组)相比,发现nKP组合并胆道疾病的比例明显升高(P=0.038),发病时中性粒细胞百分比升高更明显(P=0.002),脓肿直径更大(P=0.015);而KP组的治疗无效率更高(P=0.049)。KP组中合并眼内炎、脑膜炎的侵袭综合征7例(7/70,10%)。发生侵袭综合征组合并胆道疾病的概率更高(P=0.078),发病早期血小板下降更明显(P=0.004),且血胆红素相对更高(P=0.043)。治疗上,手术治疗组(包括外科手术及超声定位下穿刺治疗)的住院时间(15.5±8.6)d比单纯药物治疗组(20.1±17.4)d明显缩短(P=0.029)。结论肺炎克雷伯菌是细菌性肝脓肿的主要病原菌,多对头孢菌素类、氟喹诺酮类等抗菌药物敏感。发病早期需注意侵袭综合征的发生,尤其是血小板降低、黄疸明显的患者,早期给予敏感抗菌药物、相关科室的联合治疗是治愈的关键。一旦脓肿液化,应及时行有效的引流,可显著缩短病程,并能降低病死率。Objective To summarize the clinical characteristics of and our experience in managing Klebsiella pneumoniae liver abscess. Methods The clinical data of 323 patients with bacterial liver abscess treated at three hospitals in Shanghai from January 2013 to March 2016 were analyzed retrospectively. Results Bacterial culture Klebsiella pneumoniae was identified in 70 cases. Compared with the patients with K. pneumoniae, the patients without K. pneumoniae had significantly higher prevalence of biliary tract complications（P=0.038）, higher neutrophil percentage（P=0.002） and greater abscess diameter（P=0.015）. However, the patients with K. pneumoniae showed relatively higher rate of treatment failure. Invasive syndrome was identified in 7（10%） of the patients with K. pneumoniae, such as endophthalmitis, meningitis. The patients with invasive syndrome showed significantly higher prevalence of biliary tract diseases（P=0.078）, more severe thrombocytopenia at early stage（P=0.004） and higher serum bilirubin level（P=0.043）. The patients receiving surgical treatment（surgical operation and ultrasound-guided puncture） were associated with significantly shorter hospital stay（15.5±8.6） d than the patients managed with medical therapy alone（20.1±17.4） d（P=0.029）. Conclusions K. pneumoniae is one of the most common pathogens of bacterial liver abscess. K. pneumoniae is relatively susceptible to cephalosporins and fluoroquinolones. Attention should be paid to the incidence of invasive syndrome at early stage. Antimicrobial therapy should be administered timely, especially for the patients complicated with thrombocytopenia or apparent jaundice. Ultrasound-guided percutaneous drainage can shorten hospital stay and reduce mortality.

关 键 词：细菌性肝脓肿 临床特点 肺炎克雷伯菌 侵袭综合征 

分 类 号：R575.4[医药卫生—消化系统]