Purpose

The incidence of Klebsiella pneumoniae pyogenic liver abscesses (KP-PLA) is increasing. However, its diagnosis and treatment are often delayed, leading to complications. In this study, we aimed to retrospectively compare computed tomographic (CT) features of KP-PLAs with those of abscesses caused by other bacterial pathogens (non-KP-PLAS) and to further identify prognostic factors for PLA.

Methods

Data of 219 study patients including clinical presentation, comorbid conditions, metastatic infection, treatment duration, and mortality were retrospectively collated. CT characteristics of abscesses were recorded. Etiology was established by pus and/or blood culture. The differentiating CT features and clinical findings were compared between the monomicrobial KP-PLA and non-KP-PLA groups. Furthermore, factors related to in-hospital case fatality were analyzed.

Results

Multivariate analysis identified thin-walled abscesses, absent rim enhancement, metastatic infection, and absence of underlying biliary tract disease as significant predictors of KP-PLA. With 3/4 criteria applied in combination, a specificity of 96.5% was achieved for KP-PLA diagnosis. The in-hospital mortality rate was 3.7%. Multivariate analysis revealed that diabetes mellitus (P = 0.031), multiple abscesses (P = 0.026), internal gas bubble (P = 0.041), metastatic infection (P = 0.004), and septic shock (P = 0.002) were significantly associated with mortality.

Conclusion

Thin-walled abscess, metastatic infection, absence of rim enhancement, and absence of underlying biliary tract disease are potentially useful CT findings for early KP-PLA diagnosis.

中文翻译：

---

回顾性研究主要由肺炎克雷伯菌与非肺炎克雷伯菌引起的化脓性肝脓肿：CT和临床鉴别。

目的

肺炎克雷伯菌化脓性肝脓肿（KP-PLA）的发病率正在增加。但是，其诊断和治疗常常被延迟，导致并发症。在这项研究中，我们旨在回顾性比较KP-PLA与其他细菌病原体（非KP-PLAS）引起的脓肿的计算机断层扫描（CT）特征，并进一步确定PLA的预后因素。

方法

回顾性分析了219例研究患者的数据，包括临床表现，合并症​​，转移性感染，治疗持续时间和死亡率。记录脓肿的CT特征。病因是通过脓液和/或血液培养建立的。比较了单药KP-PLA组和非KP-PLA组的区别CT特征和临床表现。此外，分析了与院内病例死亡相关的因素。

结果

多变量分析确定了薄壁脓肿，缺乏边缘增强，转移性感染和根本性胆道疾病的缺乏是KP-PLA的重要预测指标。结合3/4的标准，对KP-PLA诊断的特异性达到96.5％。住院死亡率为3.7％。多因素分析显示，糖尿病（P  = 0.031），多发脓肿（P  = 0.026），内部气泡（P  = 0.041），转移性感染（P  = 0.004）和脓毒性休克（P  = 0.002）与死亡率显着相关。 。

结论

薄壁脓肿，转移性感染，缺乏边缘增强和根本性胆道疾病均可能对早期KP-PLA诊断有用。