Microbiological landscape of pyogenic liver abscesses

Abstract

Purpose of the study. To study the features of the microbial landscape of AP at different stages of their formation. Materials and methods. The results of examination and treatment of 80 patients with pyogenic liver abscesses for the period 2019–2020 were analyzed. The average age of patients was 48,4 ± 4,7 years. The duration of the disease at the time of hospitalization averaged 10,2 ± 3,4 days. The condition of all patients was assessed as moderate and severe, hospitalization was carried out on urgent indications. The inclusion criterion was the presence of pyogenic liver abscesses, the exclusion criteria were cholangiogenic and specific abscesses. Microbiological studies of the species composition of pathogens and their sensitivity to antibiotics were performed in all patients during surgery and in the dynamics of the postoperative period. Results. The microbial landscape of pyogenic abscesses in their different stages of formation differed both in quantitative and qualitative ratio. Seeding of aerobic monoinfection from purulent foci in stage I was predominant (P <0,05) and amounted to 69,4%. In this case, the aerobic gramnegative (gram (-)) flora of the foci of infection prevailed over the gram-positive (gram (+)). In stage III, the number of microbial associations sown from the purulent cell increased from 26,6 to 36,6% (P < 0,05). The increase was due to the sowing of aerobic associations. The main share among gram (-) aerobes was E. coli and Klebsiella pneumoniae, and the main representative of the mixed aerobic infection was St. auerus (including MRSA strains). In stage IV formation of pyogenic liver abscesses, the number of microbial associations sown from the purulent cell did not differ from the sowing of monoinfection (P > 0,05). There have been cases of seeding of facultative anaerobes of the genus Peptostreptococcacea and facultative anaerobic bacteria of the genus Clostridium. Conclusion. Carrying out of adequate combined ABT to patients with AP according to the developed algorithms, allowed to reduce terms of recovery of patients: for 3–4 days normalization of body temperature (t = 5,66176; P <0,000001) and a leukocyte formula (t = 8,56860; P < 0,000001) in patients of the main group compared with control patients. In turn, this contributed to a probable reduction in the length of stay of patients in the hospital for 3 days (t = 3,95561; P = 0,000116).