Drug resistance of Enterobacteriaceae bacteria causing liver abscess

Objective To investigate the drug resistance of Enterobacteriaceae bacteria which cause liver abscess, and to guide the application of antibiotics. Methods The patients with liver abscess who were hospitalized in our hospital from January 2014 to December 2017 and were found to have Enterobacteriaceae bacteria by isolation were enrolled as research subjects. Their clinical data, laboratory examination results, drug resistance data, treatment method, and outcomes were analyzed. Results Among the 53 patients, 28 ( 52. 8%) had gallbladder and biliary diseases or a surgical history, 20 ( 37. 7%) had hypertension, and 18 ( 34. 0%) had diabetes; as for clinical manifestations, 51 ( 96. 2%) had pyrexia, 33 ( 62. 3%) had liver pain or gastrointestinal symptoms, and 6 ( 11. 3%) had septic shock. Among these patients, 31 ( 58. 5%) had a leukocyte count of > 10 × 109/L, 37 ( 69. 8%) had an increase in neutrophil count, 50 ( 94. 3%) had an increase in C-reactive protein, 32 ( 60. 4%) had an increase in alanine aminotransferase, and 22 ( 41. 5%) had an increase in aspartate aminotransferase; among the 19 patients who underwent procalcitonin ( PCT) measurement, 17 ( 89. 5%) were found to have an increase in PCT. A total of 11 patients had a positive blood culture, among whom 7 ( 63. 6%) had Klebsiella pneumoniae and 4 ( 36. 4%) had Escherichia coli. Pus or bile culture identified Enterobacteriaceae bacteria strains in the 53 patients, among whom 35 ( 66. 0%) had Klebsiella pneumoniae, 12 ( 22. 6%) had Escherichia coli, 2 ( 3. 8%) had Morganella morganii subspecies, and 1 ( 1. 9%) each had Proteus penneri, Providencia rustigianii, Citrobacter freundii, and Proteus mirabilis. Among the 35 patients with Klebsiella pneumoniae, 2 had extended-spectrum beta-lactamase ( ESBL) -producing Klebsiella pneumoniae, and among the 12 patients with Escherichia coli, 9 had ESBL-producing Escherichia coli; Klebsiella pneumoniae strains were sensitive to common antibiotics, while Escherichia coli strains had high drug resistance rates to second-and third-generation cephalosporins, quinolones, and aminoglycosides. All isolates were highly sensitive to carbapenems. Conclusion Enterobacteriaceae bacteria causing liver abscess has a low ESBL-positive rate. Third-generation cephalosporins and antibiotics containing β-lactamase inhibitors are major regimens for initial empiric therapy.