肺炎克雷伯杆菌性肝脓肿不同介入治疗方法的比较

李婧; 符颖; 王吉耀; 涂传涛; 李蕾; 沈锡中; 蒋炜

肺炎克雷伯杆菌性肝脓肿不同介入治疗方法的比较

复旦大学附属中山医院消化内科

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中图分类号: R575.4
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出版历程
- 出版日期: 2010-04-20

Klebsiella pneumoniae liver abscess:comparison between the different treatment protocols

摘要

摘要: 目的本研究通过比较不同介入治疗措施对肺炎克雷伯杆菌性肝脓肿（KLA）疗效的影响以探寻相宜临床治疗流程。方法对2001年3月至2009年1月间收住入中山医院的106例KLA患者的临床资料进行回顾性分析,按治疗措施的不同将患者分为单纯穿刺组、穿刺+药物冲洗组、穿刺+单纯置管引流组及穿刺+药物冲洗+置管引流组,各组均静脉应用抗生素静脉治疗。结果与单独穿刺组相比,穿刺后行药物冲洗对KLA疗效差异无统计学意义（P>0.05）;穿刺+单纯置管组在缩小脓肿直径方面明显优于单纯穿刺组及穿刺+药物冲洗组,（34.38±3.25）mm vs（22.67±2.37）mm vs（24.45±3.17）mm,（P<0.05）;而在以甲硝唑为基础的二联抗生素应用方面,联用氟喹诺酮类或三代头孢菌素对KLA疗效差异无统计学意义（P>0.05）。结论 B超引导下经皮肝脓肿穿刺并留置导管体外引流,同时积极静脉应用抗生素是比较合理的KLA治疗程序。
- 肝脓肿 /
- 克雷伯菌,肺炎
Abstract: Objective The aim of the study is to compare the efficacy of the different protocols for treatment of Klebsiella pneumoniae liver abscesses (KLA) Methods 106 KLA patients who were treated in Zhongshan Hospital between March 2001 and January 2009 were studied retrospectively.The patients were divided into four groups based on the different therapeutic measures: mono-puncture, puncture with antibiotic flushing, puncture with retained catheter, and puncture with antibiotic flushing and retained catheter.All patients were treated with antibiotics intravenously.Results Compared to the mono-puncture, additional antibiotic flushing did not further improve clinical outcomes (P>0.05) .However, the diameter of the abscess decreased significantly with the retained catheter therapy compared to the mono-puncture or additional antibiotic flushing therapy (34.38±3.25 mm vs 22.67±2.37 mm vs 24.45±3.37 mm, P<0.05) .Combined therapy with metronidazole, tert-cephalosporin and fluoroquinolones did not show a significant difference (P>0.05) .Conclusion B-ultrasound guided puncture with retained catheter and intravenous antibiotic treatment is reasonably effective for KLA.
- liver abscess /
- klebsiella

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参考文献(10)

[1]Lee KT, Wong SR, Sheen PC. Pyogenic liver abscess: an audit of 10 years’ experience and analysis of risk factors [J]. Dig Surg, 2001, 18 (6) ∶459-466.

[2]Rahimian J, Wilson T, Oram V, et al.Pyogenic liver abscess:re-cent trends in etiology and mortality[J].Clin Infect Dis, 2004, 39 (11) ∶1654-1659.

[3]Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics [J]. Am J Gastroenterol, 2005, 100 (2) ∶322-331.

[4]Hui JY, Yang MK, Cho DH, et al. Pyogenic Liver Abscesses Caused by Klebsiella pneumoniae: US Appearance and Aspiration Findings [J]. Radiology, 2007, 242 (3) ∶769-776.

[5]Pastagia M, Arumugam V. Klebsiella pneumoniae liver abscesses in a public hospital in Queens, New York [J]. Travel Med Infect Dis, 2008, 6 (4) ∶228-233.

[6]Paterson DL, Ko WC, Von Gottberg A, et al.International prospec-tive study of Klebsiella pneumoniae bacteremia:implications of ex-tended-spectrum beta-lactamase production in nosocomial infec-tions[J].Ann Intern Med, 2004, 140 (1) ∶26-32.

[7]Kim M, Choo EJ, Keak YG, et al.The close relationship betweenciprofloxacin resistance and extendedspectrum extended-spectrumbeta-lactamases production:analysis of154 consecutive nosocomial-ly-acquired Klebsiella pneumoniae bacteremia[J].Infect Che-mother, 2004, 36 (3) ∶265-270.

[8]Chan KS, Yu WL, Tsai CL, et al. Pyogenic liver abscess caused by Klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 partients [J]. Chin Med J, 2007, 120 (2) ∶136-139.

[9]Kang CI, Kim SH, Bang JW, et al.Community-Acquired versusNosocomial Klebsiella pneumoniae Bacteremia:Clinical Features, Treatment Outcomes, and Clinical Implication of Antimicrobial Re-sistance[J].J Korean Med Sci, 2006, 21 (5) ∶816-822.

[10]Wiener J, Quinn JP, Bradford PA, et al.Multiple antibiotic-re-sistant Klebsiella and Escherichia coli in nursing homes[J].JA-MA, 1999, 281 (6) ∶517-523.

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