Objective To analyze the general condition,etiological characteristics,antibiotic use,treatment and prognosis of adult patients with pyogenic liver abscess(PLA)in order to improve the diagnosis and treatment of PLA.Methods The clinical data of adult patients diagnosed with PLA who were hospitalized in Tianjin Medical University General Hospital from December 2019 to December 2022 were retrospectively analyzed,including general information,pathogen culture and antimicrobial susceptibility testing results,treatment and outcomes.The etiological characteristics and the use of clinical anti-infective drugs were analyzed.Results A total of 280 adult patients with PLA were enrolled,including 161 males and 119 females(male/female ratio:1.35:1).The average age was 63.1±13.6 years.PLA was most frequently found in the patients of 50-80 years of age.The most common route of infection was cryptogenic infection(55.7％).The most common underlying disease was diabetes mellitus(41.1％).The positive rate of bacterial culture was 28.4％from blood,and 80.3％from pus.Klebsiella pneumoniae and Escherichia coli were the most common bacteria isolated from blood culture and pus culture.A total of 14 strains of antibiotic-resistant bacteria were identified,including 3 strains of extended-spectrum β-lactamase(ESBLs)-producing K.pneumoniae,3 strains of ESBLs-producing E.coli,1 strain of carbapenem-resistant K.pneumoniae,and 1 strain of carbapenem-resistant E.coli.There were 2 strains of methicillin-resistant Staphylococcus,3 strains of high level ampicillin and aminoglycoside resistant Enterococcus,and 1 strain of vancomycin-resistant Enterococcus.The gram-negative pathogens showed the lowest susceptibility rate to levofloxacin(82.3％)and the highest susceptibility rate to imipenem(98.2％).Overall,the gram-negative pathogens were generally susceptible to cephalosporins/β-lactamase inhibitor combinations,penicillins/β-lactamase inhibitor combinations,aminoglycosides,glycylcyclines,cephamycins,carbapenems and sulfonamides.Cephalosporins/β-lactamase inhibitor combinations are the most commonly used initial empirical treatment for PLA.Conclusions PLA is more common in men,especially the patients of 50-80 years of age and those complicated with diabetes mellitus.K pneumoniae was the major pathogen,which was sensitive to most commonly used antibiotics.The empirical treatment is mainly cephalosporins/β-lactamase inhibitor combinations.Carbapenems were also used frequently.Attention should be paid to unnecessary combination therapies and irrational use of antibiotics.
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