Antibacterial therapy of pyogenic liver abscesses

Abstract

Purpose of the study. To study the features of the microbial landscape, to develop an algorithm for antibacterial therapy in patients with pyogenic liver abscesses. Prove the effectiveness of the developed algorithm in the treatment of such patients.
 Materials and methods. The results of treatment of 79 patients with pyogenic liver abscesses were analyzed. The mean age of patients was 48,4 ± 4,7 years, with men predominating (62,9%). The inclusion criterion was the presence of pyogenic liver abscesses, the exclusion criteria were cholangiogenic and specific abscesses. The main group consisted of 44 patients operated on minimally invasive technologies based on modern diagnostic methods. They received a comprehensive conservative therapy, which took into account antibacterial treatment according to the developed algorithm. The tactics of surgical treatment of 35 patients in the control group did not differ from the main one. The groups did not differ significantly in age, sex, comorbidity, severity of the disease and the results of microbiological examination.
 Results. The number of inoculations of microorganisms from the purulent center was dominated by monoinfection – 86,4–88,6% of cases, which was mostly aerobic. Most of them were facultative anaerobic bacteria of the genus Enterobacteriaceae, namely Kl. pneumoniae – 34,1–40,1%. Less than a quarter of patients (11,4–13,6%) isolated cultures are represented by microbial associations – aerobic-anaerobic and aerobicaerobic. However, aerobic-aerobic infection prevailed – 75,0–83,3%. MRSA strains of staphylococci were isolated in 5,7–6,8% of patients. Treatment began on the first day of hospitalization. Empirical treatment was immediately prescribed, followed by antibiotic replacement, if necessary, based on the results of microbiological examination and determination of the sensitivity of the isolated cultures. According to microbiological studies, in patients with AP most of the isolated microorganisms (71,4–90,9%) were sensitive to linezalide and taigecycline. These antibacterial drugs were reserve drugs and were prescribed in extremely severe cases in the absence of sensitivity to other drugs. The effectiveness of treatment was evaluated by clinical data and improvement of laboratory parameters (normalization of body temperature and leukocyte formula).
 Conclusion. Carrying out adequate combined antibiotic therapy for patients with AP according to the developed algorithms, along with surgery, allowed to reduce the recovery time of patients: for 2–3 days normalization of body temperature (t = 5,66176; P < 0,000001) and leukocyte formula (t = 8, 56860; P < 0,000001) patients of the main group in comparison with control patients. In turn, this contributed to a probable reduction in the length of stay of the patient in the hospital for 3 days (t = 3,95561; P = 0,000116).