细菌性肝脓肿临床特点及病原学特征分析  

Analysis on clinical features and etiological characteristics of bacterial liver abscess

作　　者：于兰 王勇[1] 郭宇航[1] 王晓红[1] 付艳军[1] 李慧玲[1] 王宇超[1] 张晓丽[1] YU Lan;WANG Yong;GUO Yuhang;WANG Xiaohong;FU Yanjun;LI Huiling;WANG Yuchao;ZHANG Xiaoli(Department of Clinical Laboratory,First Affiliated Hospital of Jiamusi University,Jiamusi,Heilongjiang 154003,China)

机构地区：[1]佳木斯大学附属第一医院检验科,黑龙江佳木斯154003

出　　处：《检验医学与临床》2019年第5期592-595,共4页Laboratory Medicine and Clinic

基　　金：黑龙江省卫生和计划生育委员会科研项目(2017-405);黑龙江省大学生创新创业项目(201710222001);佳木斯大学校长创新创业基金研发项目(XZFY2018-43)

摘　　要：目的分析某院细菌性肝脓肿(BLA)临床特点及微生物学特征。方法回顾性分析94例病原学阳性的BLA患者人口学特点、临床表现、实验室及影像学指标,分析其病原学构成及预后。结果 BLA以男性多见(71.2%),发热(>38℃)多见(75.6%),潜在疾病为糖尿病(47.9%)和肝胆系统疾病(44.7%),早期实验室检查白细胞升高多见(83.0%),影像学上肝右叶病变多见(56.4%)。肺炎克雷伯菌在血液及引流液培养中检出率为77.3%,其中含产超广谱β-内酰胺酶(ESBLs)6株(8.0%),对除氨苄西林外的其他试验药物耐药率低(≤16.0%),对碳青霉烯类药物均敏感。大肠埃希菌检出率为7.2%,其中含产碳青霉烯酶肠杆菌1株(14.3%),对除氨苄西林和妥布霉素外的其他试验药物耐药率低(≤57.1%),对替加环素敏感。治愈87例(92.6%),死亡1例(1.1%)。结论 BLA病原学以肺炎克雷伯菌最常见,其次为大肠埃希菌,全部对替加环素敏感。动态监测该地区BLA的病原菌及耐药性,对合理选择抗菌药物及优化治疗方案有重要意义。Objective To analyze the clinical features and microbiological characteristics of bacterial liver abscess(BLA)in a hospital.Methods The demographic characteristics,clinical manifestation,laboratory and imaging indicators of 94 BLA patients with positive etiology were analyzed retrospectively,and their etiological components and prognosis were also analyzed.Results BLA mostly occurred in males(71.2%).Fever(>38℃)was common(75.6%),the potential diseases were diabetes(47.9%)and hepatobiliary diseases(44.7%),the leukocyte elevation(83.0%)in early laboratory examination and the right hepatic lobe lesion in imageology(56.4%)were common.The detection rate of Klebsiella pneumoniae in blood and drainage fluid culture was 77.3%,including 6 strains(8.0%)producing extended spectrumβ-lactamase(ESBLs).The drug resistance rate was low(≤16.0%)except ampicillin while were sensitive to carbapenems.The detection rate of Escherichia coli was 7.2%,including 1 strain(14.3%)of enterobacterium produced carbapenemase.The drug resistance rate to other tested drugs was low(≤57.1%)except for ampicillin and tobramycin,while was sensitive to tigacycline.In this group,87 cases(92.6%)were cured and 1 case died(1.1%).Conclusion Klebsiella pneumoniae as the BLA etiology is the most common,followed by Escherichia coli.All of them are sensitive to tigecycline.Dynamically monitoring the pathogens and drug resistance of BLA infection in this area,has an important significance for rationally selecting antibiotics and optimizing the treatment scheme.

关 键 词：细菌性肝脓肿 肺炎克雷伯菌 耐药 

分 类 号：R575.4[医药卫生—消化系统]