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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 1
Jan.  2021
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Article Contents

Clinical features of culture-negative liver abscess

DOI: 10.3969/j.issn.1001-5256.2021.01.022
  • Received Date: 2020-06-18
  • Accepted Date: 2020-07-16
  • Published Date: 2021-01-20
  •   Objective  To investigate the clinical features and prognosis of culture-negative liver abscess (CNLA) versus culture-positive liver abscess (CPLA), and to provide a reference for early diagnosis and effective treatment.  Methods  A retrospective analysis was performed for the clinical data of 371 patients with liver abscess who were admitted to The Second Affiliated Hospital of Air Force Medical University from 2005 to 2018, among whom 145 (39.1%) had positive results of pathogen test (CPLA group) and 226 (60.9%) had negative results (CNLA group). The two groups were compared in terms of clinical features, laboratory examination, imaging data, and prognosis. The t-test was used for comparison of normally distributed or approximately normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.  Results  Compared with the CNLA group, the CPLA group had a significantly older age (t=-3.464, P=0.001) and a significantly higher proportion of patients with diabetes (χ2=17.362, P < 0.001) or cardiovascular disease (χ2=10.827, P=0.001), and compared with the CPLA group, the CNLA group had a significantly higher proportion of patients with AIDS (χ2=4.354, P=0.037). Compared with the CNLA group, the CPLA group had significantly greater increases in leukocyte count, percentage of neutrophils, alkaline phosphatase, gamma-glutamyl transpeptidase, and total bilirubin (U=20393, 19711, 18586, 19349, and 18496, all P < 0.05), a significantly greater reduction in albumin (t=3.348, P=0.001), and a significantly higher proportion of patients with a baseline APACHE Ⅱ score of ≥16 (χ2=9.550, P=0.002). Compared with the CNLA group, the CPLA group had a significantly higher proportion of tumors with a diameter of > 5 cm (χ2=53.61, P < 0.001). In the CNLA group, 19.9% of the patients were treated with anti-infective therapy alone, while for both groups, anti-infective therapy combined with ultrasound- or CT-guided percutaneous drainage was the main treatment method. There were no significant differences in the length of hospital stay, recurrence rate, and mortality rate between the two groups (all P > 0.05).  Conclusion  Compared with CPLA patients, CNLA patients tend to have a younger age and are less likely to develop severe inflammatory response and liver insufficiency, with a smaller diameter of abscess which is less likely to be treated by percutaneous drainage, while there is no significant difference in prognosis between CPLA patients and CNLA patients.

     

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  • [1]
    ZHANG SY, CHEN YX. Progress in diagnosis and treatment of pyogenic liver abscess[J]. J Clin Hepatol, 2018, 34(7): 1577-1580. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.07.046

    章顺轶, 陈岳祥. 细菌性肝脓肿诊治进展[J]. 临床肝胆病杂志, 2018, 34(7): 1577-1580. DOI: 10.3969/j.issn.1001-5256.2018.07.046
    [2]
    CHEMALY RF, HALL GS, KEYS TF, et al. Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures[J]. Diagn Microbiol Infect Dis, 2003, 46(4): 245-248. DOI: 10.1016/S0732-8893(03)00088-9
    [3]
    CHEN F, ZHANG YT, QIAO HJ, et al. Clinical features of Klebsiella pneumoniae liver abscess[J]. J Clin Hepatol, 2016, 32(4): 764-768. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2016.04.034

    陈帆, 张艳亭, 乔慧捷, 等. 肺炎克雷伯菌肝脓肿的临床特征分析[J]. 临床肝胆病杂志, 2016, 32(4): 764-768. DOI: 10.3969/j.issn.1001-5256.2016.04.034
    [4]
    WU L, ZHANG J, SUN L, et al. Clinical characteristics of 70 cases of Klebsiella pneumoniae liver abscess[J]. Chin J Infect Chemother, 2018, 18(1): 11-17. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201801005.htm

    吴柳, 张洁, 孙琳, 等. 肺炎克雷伯菌肝脓肿70例临床分析[J]. 中国感染与化疗杂志, 2018, 18(1): 11-17. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201801005.htm
    [5]
    XIE N. Analysis of pathogenic bacteria in blood culture of 3905 AIDS patients[J]. Hainan Med J, 2012, 23(9): 89-91. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201209041.htm

    谢宁. 3905例艾滋病患者血培养病原菌分布结果分析[J]. 海南医学, 2012, 23(9): 89-91. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201209041.htm
    [6]
    CHEN SC, WU WY, YEH CH, et al. Comparison of Escherichia coli and Klebsiella pneumoniae liver abscesses[J]. Am J Med Sci, 2007, 334(2): 97-105. DOI: 10.1097/MAJ.0b013e31812f59c7
    [7]
    BELLMANN-WEILER R, WEISS G. Pitfalls in the diagnosis and therapy of infections in elderly patients-a mini-review[J]. Gerontology, 2009, 55(3): 241-249. DOI: 10.1159/000193996
    [8]
    YU YL, WANG JJ, WANG JY. Clinical significance of the combined detection of procalcitonin, fibrin and fibrinogen degradation products and C-reactive protein in children with sepsis[J]. J Clin Transfus Lab Med, 2018, 20(5): 521-524. (in Chinese) DOI: 10.3969/j.issn.1671-2587.2018.05.021

    余艳丽, 汪建军, 王军阳. 联合检测PCT、FDP、CRP在儿童脓毒血症中的临床价值[J]. 临床输血与检验, 2018, 20(5): 521-524. DOI: 10.3969/j.issn.1671-2587.2018.05.021
    [9]
    KHAN R, HAMID S, ABID S, et al. Predictive factors for early aspiration in liver abscess[J]. World J Gastroenterol, 2008, 14(13): 2089-2093. DOI: 10.3748/wjg.14.2089
    [10]
    CERWENKA H. Pyogenic liver abscess: Differences in etiology and treatment in Southeast Asia and Central Europe[J]. World J Gastroenterol, 2010, 16(20): 2458-2462. DOI: 10.3748/wjg.v16.i20.2458
    [11]
    CHAN DS, ARCHULETA S, LLORIN RM, et al. Standardized outpatient management of Klebsiella pneumoniae liver abscesses[J]. Int J Infect Dis, 2013, 17(3): e185-e188. DOI: 10.1016/j.ijid.2012.10.002
    [12]
    LIN C, DONG GF, ZHANG SQ, et al. Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess[J]. Zhejiang Med J, 2019, 41(16): 1701-1705. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201916007.htm

    林超, 董郭枫, 张思琴, 等. 肺炎克雷伯菌致肝脓肿的临床和微生物学特征分析[J]. 浙江医学, 2019, 41(16): 1701-1705. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201916007.htm
    [13]
    SHELAT VG, WANG Q, CHIA CL, et al. Patients with culture negative pyogenic liver abscess have the same outcomes compared to those with Klebsiella pneumoniae pyogenic liver abscess[J]. Hepatobiliary Pancreat Dis Int, 2016, 15(5): 504-511. DOI: 10.1016/S1499-3872(16)60127-3
    [14]
    YOON JH, KIM YJ, KIM SI. Prognosis of liver abscess with no identified organism[J]. BMC Infect Dis, 2019, 19(1): 488. DOI: 10.1186/s12879-019-4131-z
    [15]
    ZENG DH, ZHANG DQ, LIANG YM, et al. Evaluation of the efficacy of percutaneous transhepatic catheter drainage guided by color Doppler ultrasound in the treatment of hepatic abscess[J]. J Prac Hepatol, 2013, 16(6): 561-562. (in Chinese) DOI: 10.3969/j.issn.1672-5069.2013.06.032

    曾德辉, 张德强, 梁意敏, 等. 彩超引导下经皮经肝穿刺置管引流治疗肝脓肿的疗效评价[J]. 实用肝脏病杂志, 2013, 16(6): 561-562. DOI: 10.3969/j.issn.1672-5069.2013.06.032
    [16]
    YANG XP, ZHANG Y, WANG LS, et al. Evaluation on efficacy and safety of precise treatment guided by ultrasound for acquired immune deficiency syndrome patients with liver abscess[J/CD]. Chin J Exp Clin Infect Dis (Electronic Edition), 2017, 11(3): 277-281. (in Chinese)

    杨学平, 张瑶, 王连双, 等. 超声引导精准治疗获得性免疫缺陷综合征合并肝脓肿的疗效及安全性评价[J/CD]. 中华实验和临床感染病杂志(电子版), 2017, 11(3): 277-281.
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