최근 10년간 화농성 간농양 141예의 임상적 특성 및 원인균의 항균제 감수성 양상
Clinical Features of 141 Cases of Pyogenic Liver Abscess Over a 10-year Period and Antibiotic Sensitivity to the Causative Organisms
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Background : Pyogenic liver abscess is an acute infectious disease caused by bacteria and can become severe and potentially life-threatening, with a mortality rate of 6-18%. The purpose of this study is to provide the basic informations for the management of liver abscess and the choice of the most effective and economic antibiotics. Materials and Methods : We investigated clinical, laboratory, radiologic findings and the results of bacteriological studies retrospectively by reviewing the medical records of 141 cases of pyogenic liver abscess patients, admitted to Catholic University St Vincent's Hospital from January 1998 to December 2007. Results : Patients demographics revealed a mean age of 57.1, (age: 18 to 87), and 71 of the 141 patients were male (50.4%). Cure was achieved in 51 (98.1%) of the 52 patients who were treated with the combination of percutaneous drainage and antibiotics, and in 80 (90.0%) of 89 patients who were treated only with antibiotics. However, there were no significant differences in mortality (P=0.092) and the time to defervescence between both groups. The mean duration of percutaneous drainage was 15.8±9.7 days. Sixty-four of 141 patients showed positive culture results, and K. pneumoniae (70.3%) was the most common organism. Among 45 K. pneumoniae, the rates of resistance were 73.3% to ampicillin, 66.7% to piperacillin, 8.9% to cefazolin, 2.2% to cefuroxime, 0% to ceftriaxone, and 0% to ciprofloxacin. Conclusions : Combination treatment of intravenous antibiotics and percutaneous drainage was effective for the treatment of pyogenic liver abscess. Initial broad spectrum antibiotic coverage and then switch to first or second cephalosporin according to the susceptibility results, could be recommended especially in patients with monomicrobial K. pneumoniae liver abscess.
Abstract
Background : Pyogenic liver abscess is an acute infectious disease caused by bacteria and can become severe and potentially life-threatening, with a mortality rate of 6-18%. The purpose of this study is to provide the basic informations for the management of liver abscess and the choice of the most effective and economic antibiotics. Materials and Methods : We investigated clinical, laboratory, radiologic findings and the results of bacteriological studies retrospectively by reviewing the medical records of 141 cases of pyogenic liver abscess patients, admitted to Catholic University St Vincent's Hospital from January 1998 to December 2007. Results : Patients demographics revealed a mean age of 57.1, (age: 18 to 87), and 71 of the 141 patients were male (50.4%). Cure was achieved in 51 (98.1%) of the 52 patients who were treated with the combination of percutaneous drainage and antibiotics, and in 80 (90.0%) of 89 patients who were treated only with antibiotics. However, there were no significant differences in mortality (P=0.092) and the time to defervescence between both groups. The mean duration of percutaneous drainage was 15.8±9.7 days. Sixty-four of 141 patients showed positive culture results, and K. pneumoniae (70.3%) was the most common organism. Among 45 K. pneumoniae, the rates of resistance were 73.3% to ampicillin, 66.7% to piperacillin, 8.9% to cefazolin, 2.2% to cefuroxime, 0% to ceftriaxone, and 0% to ciprofloxacin. Conclusions : Combination treatment of intravenous antibiotics and percutaneous drainage was effective for the treatment of pyogenic liver abscess. Initial broad spectrum antibiotic coverage and then switch to first or second cephalosporin according to the susceptibility results, could be recommended especially in patients with monomicrobial K. pneumoniae liver abscess.
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