Clinical characteristics of pyogenic liver abscess
Objective To observe the main pathogens and prognosis of pyogenic liver abscess,and to analyze the clinical characteristics of patients with different ages.Methods Totally 103 patients with pyogenic liver abscess in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2021 to April 2022 were divided into elderly group(≥65 years old,n=43)and non-elderly group(＜65 years old,n=60).The age,underlying diseases,clinical symptoms,laboratory indexes,results of blood culture and pus culture,imaging features(site,number and diameter of abscess),complications(pulmonary infection,pleural effusion,sepsis and septic shock),treatment mode,length of hospital stay and prognosis were compared between two groups.Results The rate of hypertension was higher in elderly group(58.1％)than that in non-elderly group(36.7％)(x2=4.655,P=0.031),the rate of chills was lower in elderly group(67.4％)than that in non-elderly group(88.3％)(x2=6.735,P=0.009),and there were no significant differences in the rates of coronary heart disease,cerebral infarction,diabetes,fever,nausea,abdominal pain and diarrhea between two groups(P＞0.05).The percentage of neutrophil was higher in elderly group[(86.14±7.29)％]than that in non-elderly group[(83.00±7.08)％](t=2.193,P=0.031),the percentage of lymphocyte was lower in elderly group[(7.75±5.55)％]than that in non-elderly group[(10.27±5.97)％](t=2.178,P=0.032),and there were no significant differences in the white blood cell count,platelet count,prothrombin activity,hemoglobin,C-reactive protein,albumin,glutamic-pyruvic transaminase,total bilirubin,creatinine and blood glucose levels between two groups(P＞0.05).Totally 103 patients received blood culture and 67 received pus culture.The positive rates of blood culture and pus culture showed no significant differences between elderly group(46.5％,83.3％)and non-elderly group(31.7％,86.0％)(x2=2.346,P=0.126;x2＜0.001,P＞0.999).Klebsiella pneumoniae was detected by blood culture or pus culture in 62 patients(60.2％),among whom 30 patients(48.4％)had a history of diabetes.Escherichia coli was detected by pus culture in 2 patients.Staphylococcus epidermidis,Enterococcus faecalis,Bacteroides fragilis,Staphylococcus hominis,Staphylococcus capitis,Staphylococcus haemolyticus,Bacteroides polymorphus,Streptococcus intermedia,Pseudomonas aeruginosa and Streptococcus constellatus were detected by pus or blood culture in 1 patient each.There were no significant differences in the site,number and diameter of abscess,and the incidences of pulmonary infection,pleural effusion,sepsis and septic shock between two groups(P＞0.05).Sixty-seven patients received ultrasound-guided aspiration/catheter drainage combined with anti-infective treatment,among whom 1 patient was performed surgery after sufficient drainage,and 36 patients received conservative anti-infective treatment.There were no significant differences in the treatment mode and length of hospital stay between two groups(P＞0.05).Of 103 patients,98(95.1％)were discharged after recovery.Conclusions Klebsiella pneumoniae is the main pathogen in patients with pyogenic liver abscess.Both ultrasound-guided aspiration/catheter drainage combined with anti-infective treatment and conservative anti-infective treatment are effective,and the overall prognosis is good.Compared with non-elderly patients,the elderly patients have higher rate of hypertension,higher percentage of neutrophil,lower rate of chills and lower percentage of lymphocyte,with no specificity in other clinical symptoms,laboratory indexes,etiology and imaging reults.
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