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Abstract：
The incidence rate of pyogenic liver abscess caused by multidrug-resistant bacteria has increased in recent years. This study aimed to identify the clinical characteristics and risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. We conducted a retrospective analysis of the clinical features, laboratory test results, and causes of pyogenic liver abscesses in 239 patients admitted to a tertiary hospital. Multivariable logistic regression was used to identify risk factors for multidrug resistance. Among patients with pyogenic liver abscesses, the rate of infection caused by multidrug-resistant organisms was observed to be 23.0% (55/239), with a polymicrobial infection rate of 14.6% (35/239). Additionally, 71 cases (29.7%) were associated with biliary tract disease. Patients with pyogenic liver abscesses caused by multidrug-resistant organisms had a significantly higher likelihood of polymicrobial infection and increased mortality (7/44 [15.9%] vs. 3/131 [2.3%]; p = .003). The Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.06-1.68), hospitalization (aOR: 10.34, 95% CI: 1.86-60.3) or an invasive procedure (aOR: 9.62; 95% CI: 1.66-71.7) within the past 6 months, and gas in the liver on imaging (aOR: 26.0; 95% CI: 3.29-261.3) were independent risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. A nomogram was constructed based on the risk factors identified. The nomogram showed high diagnostic accuracy (specificity, 0.878; sensitivity 0.940). Multidrug-resistant organisms causing pyogenic liver abscesses have specific characteristics. Early identification of patients at high risk of infection with multidrug-resistant organisms could help improve their management and enable personalized treatment.
摘要：
近年来，由多重耐药菌引起的化脓性肝脓肿的发病率呈上升趋势。本研究旨在探讨多重耐药菌所致化脓性肝脓肿的临床特点及危险因素。我们进行了临床特征的回顾性分析，实验室测试结果，三甲医院收治的239名患者的化脓性肝脓肿原因。采用多变量logistic回归分析多药耐药的危险因素。在化脓性肝脓肿患者中，观察到由耐多药生物引起的感染率为23.0％（55/239），多微生物感染率为14.6%(35/239)。此外,71例(29.7%)合并胆道疾病。由多重耐药菌引起的化脓性肝脓肿患者发生多重微生物感染的可能性明显更高，死亡率也增加（7/44[15.9%]vs.3/131[2.3%]；p=0.003）。Charlson合并症指数(调整后比值比[aOR]：1.32，95%置信区间[CI]：1.06-1.68)，过去6个月内住院（aOR：10.34，95%CI：1.86-60.3）或侵入性手术（aOR：9.62；95%CI：1.66-71.7），肝内气体（aOR：26.0；95％CI：3.29-261.3）是多药耐药菌所致化脓性肝脓肿的独立危险因素。根据确定的风险因素构建列线图。列线图显示出较高的诊断准确性(特异性，0.878；灵敏度0.940)。引起化脓性肝脓肿的多药耐药生物具有特定的特征。早期发现多重耐药菌感染高危患者有助于改善其管理并实现个性化治疗。
