›› 2018, Vol. 38 ›› Issue (12): 1463-.doi: 10.3969/j.issn.1674-8115.2018.12.012

• Original article (Clinical research) • Previous Articles     Next Articles

Influence of multi-drug-resistant Gram-negative bacteria infections on the process and prognosis of moderately severe acute pancreatitis and severe acute pancreatitis

XU Zhi-wei1, QIN Shuai2, LI Lei2, QU Hong-ping2, MAO En-qiang3, HUANG Jie2   

  1. 1. Department of Pancreatic Surgery, 2. Department of Critical Care Medicine, 3. Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2018-12-28 Published:2019-01-27

Abstract: Objective · To analyze the bacterial origin and characteristics, and their influence on the process and prognosis in moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) patients with pancreatic/peri-pancreatic infections due to multiple drug resistant (MDR) Gram-negative bacteria (GNB). Methods · Patients of pancreatitis hospitalized in the Departments of Emergency, Pancreatic Surgery and Critical Care Medicine were enrolled in this study. The patients with pancreatic/peri-pancreatic GNB infections were screened and divided into MDR-GNB group and non-MDRGNB group. The basic clinical features, the source of resistant bacteria, the progress of the disease and the prognosis were analyzed and compared within two groups. Results · 92(46.70%) out of 197 MSAP and SAP patients were confirmed as GNB infected, 61 cases (66.30%) with MDR strains and 31 cases (33.70%) with non-MDR strains. 117 GNB were isolated. The main MDR strains were Klebsiella pneumoniae (KP) (39/69) and Acinetobacter Baumannii (AB) (22/69). The incidence of percutaneous catheter drainage (PCD) associated MDR bacterial infections in MDR-GNB group was significantly higher than that of non-MDR-GNB group (36.07% vs 12.90%, P0.020). The MDR-GNB infections could lead to prolonged mechanical ventilation[ (17.65±11.74) d vs (9.67±9.34) d, P0.001], increased of carbapenems and special antibiotics (P0.000), earlier intervention of first laparotomy [(21.92±11.45) d vs (29.36±21.48) d, P0.032], increased incidence of multiple operations (45.90% vs 22.58%, P0.029), prolonged total hospitalization [(54.44±42.38) d vs (32.51±27.62) d, P0.011] and higher mortality (34.43% vs 12.90%, P0.028). The incidence of MDR-KP infections in death patients was significantly higher than that in the surviving patients (85.71% vs 52.50%, P0.000), while the other MDR bacteria did not present statistical difference in the two groups. Conclusion · MDRKP and MDR-AB are the main resistant GNB in MSAP and SAP patients with pancreatic/peri-pancreatic infections. The PCD associated infection is the main source of nosocomial MDR bacterial infections. Infections due to MDR-GNB could lead to prolonged therapy course, increased of antibiotics, augmented operation, and poor outcome. The infection of MDR-KP is directly related to poor outcome.

Key words: acute pancreatitis, multiple drug resistant, Gram-negative bacteria, prognosis

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