分析了307例单中心肝脓肿患者中的15例病例。
Analysis of 15 cases from a monocentric cohort of 307 liver abscesses.
发表日期：2023 Aug 03
作者：
Etienne Canouï, Geoffrey Rossi, Yann Nguyen, Emmanuel Lafont, Benjamin Rossi, Olivier Roux, Safi Dokmak, Frédéric Bert, Véronique Leflon-Guibout, Bruno Fantin, Agnès Lefort
来源：
MYCOSES
摘要：
在血液病患者的背景下，Candida sp. 很少从化脓性肝脓肿（PLA）中检出。我们的目的是评估Candida化脓性肝脓肿（C-PLA）的发生风险因素、临床、微生物学特征、治疗及结果。我们对C-PLA病例进行了回顾性分析，并将其与我们单中心肝脓肿数据库中仅由细菌引起的化脓性肝脓肿（B-PLA）进行了比较。不良进展被定义为初次治疗失败（PTF）发生，初始治愈后复发，或在诊断后3个月内死亡。在2010年至2018年期间，共纳入了15例C-PLA和292例B-PLA。所有C-PLA均为胆道起源且多菌感染。所有C-PLA患者至少有一种易感于Candida感染的合并症，并且有7例（53.3%）出现了需要住进重症监护室的脓毒症。抗真菌治疗的中位持续时间为42天[24-55]。在多因素分析中，与B-PLA相比，恶性肿瘤病史（OR 4.16; 95%CI 1.15-18.72）或肝脓肿病史（OR 7.39; 95%CI 2.10-26.62）以及严重脓毒症（OR 3.52; 95%CI 1.07-11.90）与C-PLA的发生率独立相关。在多因素分析中，C-PLA与复发风险较高相关（HR 3.08; 95%CI 1.38-11.22）。非中性粒细胞减少的Candida肝脓肿是一种罕见且严重的疾病。高复发率应引起进一步讨论更加强化的治疗方案。© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.
Out of the context of haematological patients, Candida sp. is rarely retrieved from pyogenic liver abscesses (PLA).Our objective was to assess the risk factors for occurrence, and clinical, microbiological characteristics, management and outcome of Candida pyogenic liver abscesses (C-PLA).We retrospectively analysed C-PLA cases and compared them to pyogenic liver abscesses exclusively due to bacteria (B-PLA) included in our monocentric database on liver abscesses. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence after an initial cure, or death within 3 months after diagnosis.Between 2010 and 2018, 15 C-PLA and 292 B-PLA were included. All C-PLA had a biliary origin and were polymicrobial. All patients with C-PLA had at least one comorbidity at risk for Candida infection and 7 (53.3%) presented with sepsis requiring an admission in intensive care unit. Median duration of antifungal treatment was 42 days [24-55]. In multivariate analysis, compared with B-PLA, a medical history of malignancy (OR 4.16; 95%CI 1.15-18.72) or liver abscess (OR 7.39; 95%CI 2.10-26.62), and sepsis with severity criteria (OR 3.52; 95%CI 1.07-11.90) were independently associated with the occurrence of C-PLA. In multivariate analysis, C-PLA was associated with a higher risk of recurrence (HR 3.08; 95%CI 1.38-11.22).Candida liver abscesses in non-neutropenic is a rare and severe disease. The high rate of recurrence should lead to discuss a more intensive treatment.© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.