Clinical features of Klebsiella pneumoniae liver abscess

Objective To analyze the clinical data of Klebsiella pneumoniae liver abscess( KPLA),and to provide a reference for early diagnosis and proper treatment. Methods The etiological features of 156 patients with bacterial liver abscess( BLA) and positive culture results who were hospitalized in The First Hospital Affiliated to Nanjing Medical University from March 2009 to July 2015 were analyzed retrospectively. According to the culture results,BLA patients were divided into KPLA group( 81 patients) and non- KPLA( NKPLA) group( 61 patients),and other positive strains including Escherichia coli were found in the other 14 patients with positive culture results for Klebsiella pneumoniae. The clinical,laboratory,and imaging data of KPLA and NKPLA were compared. The t- test was applied for comparison of normally distributed continuous data between groups,and the Mann- Whitney U test was applied for continuous data with skewed distribution between groups; the chi- square test or Fisher's exact test was applied for comparison of categorical data between groups. Results The most common pathogenic bacteria for BLA were Klebsiella pneumonia. In comparison with the NKPLA group,the KPLA group had a significantly higher proportion of male patients( χ~2= 4. 50,P = 0. 03),a significantly higher proportion of patients with diabetes( χ~2= 27. 28,P < 0. 001),and a significantly lower proportion of patients who complained of abdominal pain( χ~2= 5. 24,P = 0. 02). In the aspects of underlying diseases,the prevalence of biliary tract diseases,previous abdominal surgery,and a history of intraperitoneal tumors showed significant differences between the NKPLA group and the KPLA group( χ~2= 18. 38,20. 87,and 21. 68,all P < 0. 001). As for laboratory examination,the NKPLA group had a significantly greater reduction in hemoglobin compared with the KPLA group( t = 4. 903,P < 0. 001). In terms of imaging examination,most BLA patients showed a single lesion in the right lobe of the liver,but the KPLA group had a significantly higher proportion of patients with the formation of separation( χ~2= 4. 16,P = 0. 04). The patients in both groups experienced complications including pulmonary infection,pleural effusion,and perinephric infection. Most patients were treated with antibiotics combined with puncture,and the KPLA group had a significantly higher response rate than the NKPLA group( 93. 83% vs 80. 33%,χ~2= 6. 02,P = 0. 01).Conclusion The most common pathogenic bacteria for BLA are Gram- negative bacilli,especially Klebsiella pneumoniae. KPLA occurs more commonly in males,and most of the patients have diabetes. The clinical manifestations are not obvious,and the patients tend to develop the complications such as pleural effusion and pulmonary infection. Imaging examination should be performed as early as possible and proper treatment should be given in time.