Bacterial flora distribution and antimicrobial resistance of pyogenic liver abscess: a multicenter retrospective study (A report of 897 cases)

Objective To investigate the bacterial flora distribution and antimicrobial resistance of patients with pyogenic liver abscess (PLA) in multi-centers of China. Methods The retrospective and descriptive study was conducted. The clinical data of 897 patients with PLA at 3 medical centers in China from October 2007 to April 2018 were collected, including 656 cases in the First Hospital of Harbin Medical University, 109 cases in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and 132 cases in the Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University. There were 582 males and 315 females, aged (59±11)years, with a range of 6-86 years. Observation indicators: (1) bacterial flora distribution; (2) bacterial resistance. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. Results (1) Bacterial flora distribution: among 897 patients, 733 cases of Klebsiella pneumoniae, 75 cases of Escherichia coli, 11 cases of Staphylococcus aureus, 10 cases of Streptococcus viridians, 9 cases of Klebsiella pneumoniae subsp. pneumoniae, 7 cases of β-emolytic streptococcus, 6 cases of Acinetobacter baumannii, 5 cases of Streptococcus intermadius, 5 cases of Enterococcus faecium, 3 cases of Alcaligenes xylosoxidans subsp. xylosoxidans, 2 cases of Proteus mirabilis, 2 cases of Streptococcus isthmus, 2 cases of Enterobacter cloacae subsp. cloacae, 1 case of Citrobacter koseri, 1 case of Proteus vulgaris, 1 case of Pasteurella pneumotropica, 1 case of Curobacter freudii, 1 case of Enterobacter amnigenus, 1 case of Stenotrophomonas maltophilia, 1 case of Acinetobacter lwoffii, 1 case of Streptococcus salivarius, 1 case of Streptococcus bacterium, 1 case of Enterococcus avium, 1 case of Enterococcus faecalis, 1 case of Klebsiella oxytoca, and 1 case of Staphylococcus epidermidis were cultured in the pus respectively. There were 12 cases of double bacterial infection, and 2 cases of multiple bacterial infections. (2) Bacterial resistance. ① Resistance of Klebsiella pneumoniae and Escherichia coli: the drug resistance rates of Klebsiella pneumoniae to ampicillin, piperacillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefotetan, cefepime, cefoxitin, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, ertapenem, gentamicin, tobramycin, amikacin, tigaricycline, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 99.79%(474/475), 4.09%(7/171), 12.18%(82/673), 7.34%(49/668), 2.34%(4/171), 1.96%(11/562), 5.85%%(10/171), 0(0/562), 0.55%(4/733), 1.42%(9/635), 0(0/733), 2.46%(18/733), 0.55%(4/733), 0.27%(2/733), 1.36%(10/733), 0.14%(1/733), 0(0/733), 0.36%(2/562), 0.95%(7/733), 0.41%(3/733), 0(0/733), 0(0/562), 1.64%(12/733), 0.95%(7/733), and 4.50%(33/733), respectively. The drug resistance rates of Escherichia coli to above antibiotics were 78.67%(59/75), 40.91%(18/44), 65.33%(49/75), 56.00%(42/75), 38.64%(17/44), 41.94%(13/31), 20.00%(15/75), 3.23%(1/31), 25.33%(19/75), 5.77%(3/52), 18.67%(14/75), 32.00%(24/75), 8.00%(6/75), 16.00%(12/75), 37.33%(28/75), 1.33%(1/75), 0(0/75), 0(0/31), 40.00%(30/75), 14.67%(11/75), 1.33%(1/75), 0(0/31), 54.67%(41/75), 37.33%(28/75), and 52.00%(39/75), respectively. ② Drug resistance of other Gram-negative bacteria: the drug resistance rates of Klebsiella pneumoniae subsp. pneumoniae to ampicillin, cefazolin, cefuroxime, ceftriaxone, ceftazidime, cefotetan, cefepime, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, ertapenem, gentamicin, tobramycin, amikacin, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 8/8, 0/5, 0/5, 0/1, 0/9, 0/2, 0/9, 0/8, 0/9, 0/9, 0/6, 0/9, 0/9, 0/7, 0/1, 0/9, 0/8, 0/9, 0/9, 0/9, and 0/9. The drug resistance rates of Acinetobacter baumannii to ceftriaxone, ceftazidime, cefepime, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, gentamicin, tobramycin, amikacin, tigaricycline, ciprofloxacin, levofloxacin, and trimethoprim sulfamethoxazole were 2/6, 4/6, 3/6, 0/6, 4/6, 1/6, 2/6, 4/6, 2/6, 4/6, 4/6, 3/6, 0/6, 4/6, 2/6, and 3/6, respectively. The drug resistance rates of Alcaligenes xylosoxidans subsp. xylosoxidans to ampicillin, cefazolin, cefuroxime, ceftazidime, cefepime, amoxicillin/carat Retinoic acid, piperacillin/tazobactam, aztreonam, imipenem, gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin were 3/3, 3/3, 3/3, 1/3, 1/3, 1/3, 0/3, 3/3, 2/3, 3/3, 3/3, 3/3, 3/3, and 1/3. ③ Drug resistance of other Gram-positive bacteria: the drug resistance rates of Staphylococcus aureus to penicillin, ampicillin, piperacillin, cefazolin, cefuroxime, cefotaxime, ceftazidime, cefepime, cefoxitin, amoxicillin/carat Retinoic acid, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, meropenem, gentamicin, tobramycin, amikacin, tetracycline, tigaricycline, ciprofloxacin, levofloxacin, moxifloxacin, trimethoprim sulfamethoxazole, linezolid, erythromycin, clindamycin, vancomycin, teicoplanin, and rifampin were 2/6, 6/8, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 4/5, 3/5, 2/5, 2/5, 3/8, 3/5, 3/5, 0/8, 0/8, 3/8, 3/11, 0/5, 1/8, 0/8, 0/8, 2/6, 3/3, 1/3, and 0/3. The drug resistance rates of Streptococcus viridians to penicillin, ampicillin, ceftriaxone, cefoperazone/sulbactam, gentamicin, tetracycline, ciprofloxacin, levofloxacin, moxifloxacin, linezolid, erythromycin, clindamycin, vancomycin, teicoplanin, and rifampin were 3/10, 0/8, 0/7, 0/7, 2/8, 6/10, 0/8, 0/8, 0/7, 0/5, 4/10, 6/10, 0/5, 0/5, and 0/3. The drug resistance rates of β-emolytic streptococcus to antibacterial agents were 0. ④ Drug resistance of complex bacteria. For the 12 patients with double bacterial infection, in the Klebsiella pneumoniae combined with Gram-negative bacteria, the drug resistance rates of Klebsiella pneumoniae to cefotetan, cefoxitin, ampicillin/sulbactam, meropenem, ertapenem, tobramycin, tigecycline, and trimethoprim sulfamethoxazole were 0. The drug resistance rates of Acinetobacter baumannii to ertapenem, levofloxacin, and trimethoprim sulfamethoxazole were 0. The drug resistance rates of Escherichia coli to ceftazidime, cefoxitin, amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, meropenem, ertapenem, tobramycin, amikacin, and tigecycline were 0. Citrobacter florida was sensitive to other antibiotics than levofloxacin and trimethoprim cotrimoxazole. In the Escherichia coli combined with Gram-positive bacteria, the drug resistance rates of Escherichia coli to cefotetan, cefepime, cefoxitin, cefoperazone/sulbactam, meropenem, tobramycin, and amikacin were 0. The drug resistance rates of Enterococcus faecalis to penicillin, ampicillin, levofloxacin, moxifloxacin, linezolid, vancomycin, and teicoplanin were 0. The drug resistance rates of Enterococcus casselifavus to ampicillin, tetracycline, levofloxacin, moxifloxacin, linezolid, and erythromycin were 0. The drug resistance rates of Staphylococcus hominis subspecies to levofloxacin, moxifloxacin, linezolid, vancomycin, teicoplanin, and rifampicin were 0. The drug resistance rates of Enterococcus faecium to tetracycline, linezolid, vancomycin, and teicoplanin were 0. In the multiple bacterial infections of Klebsiella pneumoniae + Escherichia coli + Staphylococcus aureus subspecies + Pseudomonas aeruginosa + Torulopsis glabrata, the drug resistance rates of Klebsiella pneumoniae to ceftriaxone, ceftazidime, cefotetan, cefepime, cefoxitin, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, tobramycin, amikacin, and levofloxacin were 0. The drug resistance rates of Escherichia coli to ceftazidime, cefotetan, cefepime, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, and amikacin were 0. The drug resistance rates of Staphylococcus aureus subspecies to ceftriaxone, ceftazidime, cefotetan, cefepime, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, aztreonam, imipenem, tobramycin, amikacin, tigecycline, moxifloxacin, cotrimoxazole, teicoplanin, vancomycin, linezolid, and clindamycin were 0. The drug resistance rates of Pseudomonas aeruginosa to ceftazidime, cefepime, piperacillin/tazobactam, imipenem, gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin were 0. The drug resistance rates of Torulopsis glabrata to 5-fluorocytosine, fluconazole, itraconazole, and voriconazole were 0. In the multiple bacterial infections of Klebsiella pneumoniae + Escherichia coli + Acinetobacter baumannii, the drug resistance rates of Klebsiella pneumoniae to cefotetan, cefepime, piperacillin/tazobactam, imipenem, ertapenem, tobramycin, ciprofloxacin, and levofloxacin were 0. The drug resistance rates of Escherichia coli to amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, meropenem were 0. The drug resistance ratets of Acinetobacter baumannii to trimethoprim sulfamethoxazole was 0. Conclusions Klebsiella pneumoniae is the main pathogen of PLA, followed by Escherichia coli. Klebsiella pneumoniae and Escherichia coli are sensitive to meropenem and tigecycline. Klebsiella pneumoniae subsp. pneumoniae and other Gram-negative bacteria are sensitive to ertapenem. Staphylococcus aureus are sensitive to Linezolid. Antibiotics are selected after drug sensitivity test for patients. Key words: Infection; Pyogenic liver abscess; Bacterial distribution; Drug resistance; Drug sensitivity; Multicenter study