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A wide clinical spectrum of pulmonary affection in subjects with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA)

  • Author Footnotes
    1 Ziwen Zhu and Beilei Zhang contributed equally and were regarded as co-first authors.
    Ziwen Zhu
    Footnotes
    1 Ziwen Zhu and Beilei Zhang contributed equally and were regarded as co-first authors.
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
    Search for articles by this author
  • Author Footnotes
    1 Ziwen Zhu and Beilei Zhang contributed equally and were regarded as co-first authors.
    Beilei Zhang
    Footnotes
    1 Ziwen Zhu and Beilei Zhang contributed equally and were regarded as co-first authors.
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
    Search for articles by this author
  • Yang Wang
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
    Search for articles by this author
  • Suxian Jing
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
    Search for articles by this author
  • Weiwei Ning
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
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  • Chao Liu
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
    Search for articles by this author
  • Cheng Chen
    Correspondence
    Corresponding author.
    Affiliations
    Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
    Search for articles by this author
  • Author Footnotes
    1 Ziwen Zhu and Beilei Zhang contributed equally and were regarded as co-first authors.
Published:September 20, 2022DOI:https://doi.org/10.1016/j.jiac.2022.09.011

      Abstract

      Background

      Klebsiella pneumoniae is a major pathogen of bacterial liver abscess in Asia. Particularly, patients with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA) tend to have a higher risk of invasive infection and pulmonary is a common invasive infectious site, making it a global clinical crisis. Therefore, considerable attention should be focused on the early prediction and active treatment strategies of such patients.

      Methods

      The clinical data of 127 CA-KPLA cases hospitalized from January 2017 to February 2022 were collected from a single center. Risk factors were analyzed by the use of univariable and multivariable analysis. Furthermore, independent risk factors of pulmonary affection were utilized to construct a predictive nomogram.

      Results

      The incidence of pulmonary affection in KPLA patients was 57.5% (73/127) and the majority manifested as nodular lesions with cavities and pleural effusion in chest CT images. Based on the predictive nomogram, the SOFA score (>2) was defined as the most dominant independent risk factor for the occurrence of pulmonary affection, followed by the maximum diameter of liver abscess (>3 cm), multiple liver abscesses, bacteremia, and badly-controlled diabetes sequentially. The validation of this nomogram also demonstrated good discriminative ability and satisfactory consistency. Finally, early drainage of liver abscess, initial combinational antibiotics, and early Carbapenem-including antibiotic usage were established as favorable factors for therapy in pulmonary affected CA-KPLA patients.

      Conclusion

      This study provided an effective model for the early prediction of pulmonary affection in patients with CA-KPLA and some rational strategies for their early therapeutic remission.

      Keywords

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