Antibiotic Strategy for Pyogenic Liver Abscess: One Medical Center Experience in Taiwan

治療細菌性肝膿瘍之抗生素使用策略：一家台灣醫學中心之經驗

張德生(Te-Sheng Chang) ； 董水義(Shui-Yi Tung) ； 戴達英(Dar-In Tai) ； 李宜霖(I-Lin Lee) ； 沈建亨(Chien-Heng Shen) ； 魏國良(Kuo-Liang Wei) ； 莊家盛(Chia-Sheng Chuang) ； 謝詠諭(Yung-Yu Hsieh) ； 吳正雄(Cheng-Shyong Wu)

《臺灣消化醫學雜誌》 27卷1期 (2010/03) Pp. 1-11

https://doi.org/10.6557/GJT.201003_27(1).0001

摘要

背景：對於細菌性肝膿瘍的抗生素治療原則並無共識，本回溯性研究欲證明以保守的遞增性抗生素治療策略與全面廣效性抗生素治療效果相當。
方法：對自2002年1月至2005年7月間122位出院診斷爲細菌性肝膿瘍的病息做回溯性分析，除了給予肝膿瘍引流治療外，這些病患同時開始接受靜脈注射cefazolin及gentamicin的抗生素治療，分析結果與英文文獻肝膿瘍死亡率作比較；並探討死亡、復發、遠處轉移感染、需開刀治療等複雜併發症及不良預後的危險因子。
結果：在122病例中有12例死亡，死亡率爲10%，與英文文獻記錄相當。有73例(60%)不需調整cefazolin及gentamicin的處方。共有38例出現不良併發症，其中包括15例需接受開刀手術，12例死亡，6例復發及5例遠處轉移感染。單變數分析顯示肝硬化(OR=5.643, P=0.004)、膽道疾病(OR=3.440, P=0.006)、肋膜積液(OR=3.556, P=0.003)、膿瘍破裂(OR=43.160, P=0.0001)、黃膽(2.67±2.45 vs. 1.67±1.82 mg/dL, P=0.013)及貧血(11.6±2.43 vs. 12.53±1.88 g/dL, P=0.024)是出現併發症及不良預後的危險因子；多變數分析則顯示肝硬化(P=0.004)、膿瘍破裂(P=0.0001)及膽道疾病(P=0.0001)是獨立危險因子。
結論：cefazolin及gentamicin的抗生素處方對大多數細菌性肝膿瘍的治療已是足夠，肝硬化、膿瘍破裂及膽道疾病則是不良預後的獨立危險因子。

關鍵字

細菌性肝膿瘍 ； 抗生素治療 ； 危險因子

並列摘要

Background and Aim: There is currently no consensus on antibiotic treatment for pyogenic liver abscess. This retrospective study intends to verify the equivalent effects between the step-up antimicrobial strategy and indiscriminate broad-spectrum antibiotic treatment for this disease.
Methods: One hundred twenty-two consecutive patients with pyogenic liver abscess were retrospectively analyzed. In addition to abscess drainage, they were preferentially treated with a conservative regimen of parenteral antibiotics with cefazolin plus gentamicin at presentation. The mortality rate was compared with that of studies published in English-language medical literature. The complicated group, with mortality, metastatic infections, relapsed diseases, and involuntary surgeries, was compared with its contrary uncomplicated group to identify the risk factors for unfavorable clinical courses and outcomes.
Results: The mortality rate was 10% (12/122), which was comparable to results documented in the English-language literature. There were 38 patients in the complicated group and 84 patients in the uncomplicated group. Seventy- three patients (60%) did not require modification of their cefazolin plus gentamicin regimen. Univariate analysis revealed that liver cirrhosis (OR=5.643, P=0.004), biliary disease (OR=3.440, P=0.006), pleural effusion (OR=3.556, P=0.003) and abscess rupture (OR=43.160, P=0.0001) were risk factors for complicated outcomes. Clinical jaundice (2.67±2.45 νs. 1.67±1.82 mg/dL, P=0.013) and anemia (11.6±2.43 νs. 12.53±1.88 g/dL, P=0.024) also reached the statistical significance. Multivariate logistic regression analysis revealed that liver cirrhosis (P=0.004), abscess rupture (P=0.0001) and biliary disease (P=0.0001) were independent risk factors.
Conclusion: Cefazolin plus gentamicin suffices for most patients with pyogenic liver abscess. Liver cirrhosis, biliary disease, and abscess rupture are independent risk factors for a complicated disease course.

並列關鍵字

pyogenic liver abscess ； antibiotic treatment ； risk factors