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master's thesis
39
13
LIVER ABSCESSES TREATED IN THE CLINIC FOR INFECTIOUS DISEASES – CLINICAL HOSPITAL SPLIT IN THE PERIOD 2005-2015
EPIDEMIOLOGY, CLINICAL FEATURES AND TREATMENT
Ante Dobričić (2016)
University of Split
School of Medicine
Infectology
Cite this item:
https://urn.nsk.hr/urn:nbn:hr:171:610977
Metadata
Title
APSCESI JETARA LIJEČENI NA KLINICI ZA INFEKTOLOGIJU KLINIČKOG BOLNIČKOG CENTRA SPLIT U RAZDOBLJU 2005.-2015. : EPIDEMIOLOGIJA, KLINIČKA SLIKA I TERAPIJA
Author
Ante Dobričić
Mentor(s)
Ivo Ivić
(thesis advisor)
Abstract
CILJEVI: Ciljevi ovog istraživanja bili su utvrditi glavne demografske i predispozicijske čimbenike bolesnika s jetrenim apscesima, istražiti glavne simptome, fizikalne i laboratorijske nalaze te pokušati zaključiti koje su bakterije najčešći uzročnici jetrenog apscesa kako bi mogli predložiti najbolju empirijsku antimikrobnu terapiju. MATERIJALI I METODE: Istraživanje je obuhvatilo 25 pacijenata sa radiološki dokazanim jetrenim apscesom koji su liječeni na Klinici za infektologiju KBC-a Split u periodu od 10 godina (2005.-2015.). Provedena je retrospektivna opažajna studija uvidom u povijesti bolesti i otpusna pisma pacijenata. REZULTATI: Dijabetes tipa 2 ustanovljen je u gotovo 50 % bolesnika. Najčešće primarno sjelo infekcije bio je biliarni sustav ( akutni holangitis i holecistitis) u 40% bolesnika. Ostali rizični faktori ili primarna sijela infekcije bili su karcinom kolona, pijelonefritis, pankreatitis te asplenija. Najčešći simptom je bila vrućica u 100% naših bolesnika. Više od polovine bolesnika je bila visokofebrilna (>39 º C). 68% bolesnika žalilo se na spontanu bol u trbuhu, ali je ona bila varijabilne lokalizacije. Suhi kašalj bio je čest simptom u naših bolesnika(48%). U krvnoj slici CRP je bio povišen u svih bolesnika. Leukocitozu je imalo 76% bolesnika, a neutrofiliju 88% bolesnika. GGT bila je povišena u 72% bolesnika, a alkalna fosfataza u 44%. Bilirubin je bio povišen u 36% bolesnika. Najčešći izolirani uzročnik bila je K. Pneumoniae koja je izolirana iz 3 hemokulture. 11 bolesnika (44%) s apscesima manjim od 5 cm izliječeni su samo antimikrobnom terapijom. ZAKLJUČAK: Večina naših bolesnika bile su osobe s dijabetesom i bolestima bilijarnog sustava i gušterače. Bolest se najčešće manifestirala kao vrućica nepoznatog uzroka, a niti jedan drugi simptom nije bio ni dovoljno učestao niti dovoljno specifičan da bi upučivao na lokalizaciju infekcije. CT trbuha pouzdanija je slikovna pretraga od UZV u dijagnostici jetrenih apscesa. Enterobakterije sa/bez B. Fragilis najčešće su izolirane bakterije iz hemokulture/gnoja dobivenog drenažom. Njihova antibiotska osjetljivost opravdava empirijsko korištenje beta-laktama širokog spektra poput ko-amoksiklava ili ceftriaksona u kombinaciji s metronidazolom. Drenaža nije primjenjivana u bolesnika s apscesima manjim od 5 cm ako su na antibiotsku terapiju odgovorili padom temperature i upalnih parametara u krvi.
Keywords
Liver Abscess
Parallel title (English)
LIVER ABSCESSES TREATED IN THE CLINIC FOR INFECTIOUS DISEASES – CLINICAL HOSPITAL SPLIT IN THE PERIOD 2005-2015 : EPIDEMIOLOGY, CLINICAL FEATURES AND TREATMENT
Granter
University of Split
School of Medicine
Lower level organizational units
Infectology
Place
Split
State
Croatia
Scientific field, discipline, subdiscipline
BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Infectology
Study programme type
university
Study level
integrated undergraduate and graduate
Study programme
Medicine
Academic title abbreviation
dr. med.
Genre
master's thesis
Language
Croatian
Defense date
2016
Parallel abstract (English)
OBJECTIVES: The aim of this research was to determine the main demographic and pre-dispositional factors in patients diagnosed with liver abscesses and to investigate the main symptoms and laboratory reports in order to conclude which bacteria is the most common cause of liver abscess, and therefore suggest the best empirical antimicrobial therapy. MATERIALS AND METHODS: The research was done on the corpus of 25 patients with determined liver abscess who were treated in Infectology Department of Clinical Hospital Split in the period of 10 years (2005-2015). Retrospective observational study was performed with the insight into the history of illness and discharge letters of the patients. RESULTS: Diabetes type 2 was confirmed in almost 50 % of the patients. The most common initiator was biliary system (acute cholangitis and cholecistitis) in 40% of the patients. Other factors of risk or the initiators of infections were colon cancer, pyelonephritis, pancreatitis and asplenia. The most common symptom was fever, in 100% of our patients. More than half of the patients had high fever (>39 º C). 68% of the patients felt spontaneous abdominal pain, differently localized. The second most common symptom that 48 % of the patients complained was dry cough. Blood test showed higher CRP in 100% of the patients. 76% of the patients had leukocytosis and 88% neutrophilia. GGT was higher in 72% of the patients and alkaline fosfatase in 44%. High bilirubin was found in 36% of the patients. The most common isolated cause was K. Pneumoniae, that was isolated from 3 hemocultures. 11 patients (44%) diagnosed with abscesses smaller than 5 cm were treated with antimicrobial therapy. CONCLUSION: Most of our patients were diagnosed with diabetes mellitus and biliary and pancreas system illnesses. The illness mostly manifested as a fever of unknown cause, and no other symptom was common enough to point to the infection localization. Abdomen CT scan is more reliable than ultrasound in liver abscesses diagnosis. Enterobacteriaceae with or without B. fragilis were the most common isolated bacteria from hemoculture . Its antibiotic sensitivity justifies empirical use of wide specter beta-lactam such as co-amoxiclav or ceftriaxone in combination with metronidazole. Drainage was not performed with the patients diagnosed with abscesses smaller than 5 cm if they responded to the antibiotic therapy with temperature decrease and inflammatory blood parameters.
Parallel keywords (Croatian)
Apsces jetre
Resource type
text
Access condition
Open access
Terms of use
URN:NBN
https://urn.nsk.hr/urn:nbn:hr:171:610977
Committer
Linda Ivas