接受手术坏死组织清除术或经皮坏死分泌物引流术的坏死性胰腺炎中的局部和全身细菌感染。
Localized and systemic bacterial infections in necrotizing pancreatitis submitted to surgical necrosectomy or percutaneous drainage of necrotic secretions.
作者信息
Cacopardo Bruno, Pinzone Marilia, Berretta Salvatore, Fisichella Rossella, Di Vita Maria, Zanghì Guido, Cappellani Alessandro, Nunnari Giuseppe, Zanghì Antonio
出版信息
BMC Surg. 2013;13 Suppl 2(Suppl 2):S50. doi: 10.1186/1471-2482-13-S2-S50. Epub 2013 Oct 8.
BACKGROUND
Infectious complications are observed in 40-70% of all patients with severe acute pancreatitis. Infections are associated with a significant increase in mortality rates.
METHODS
We evaluated the prevalence and characteristics of pancreatic and systemic infections in 46 patients with necrotizing pancreatitis submitted to surgical procedures during their hospital stay as well as the impact of such infectious complications on patient clinical outcome. Samples for microbiological cultures were taken at hospital admission from blood and bile and 2 days after invasive procedure from blood, drainage fluid, bile and necrotic tissues.
RESULTS
74% patients with necrotizing pancreatitis had a localized or systemic infection. At admission, 15% of subjects had positive blood cultures whereas 13% had evidence of bacterial growth from bile cultures. Two days after the invasive procedures for removal of necrotic materials and fluids, blood cultures became positive in 30% of patients in spite of antibiotic prophylaxis and bile cultures resulted positive in 22% of cases. Furthermore, bacterial growth from drainage fluids was found in 30% and from homogenized necrotic material in 44% of cases. As refers to bacterial isolates, all patients had a monomicrobial infection. Carbapenems were the drugs with the best sensitivity profile.
CONCLUSIONS
Infectious complications significantly increase mortality in patients with necrotizing pancreatitis. In addition, subjects with systemic infections developed more complications and demonstrated a higher mortality rate in comparison with those having a localized infection. In our study, the sensitivity pattern of the isolated microorganisms suggests to consider carbapenems as the best option for empirical treatment in patients with necrotizing pancreatitis who develop a clear-cut evidence of systemic or localized bacterial infection.
背景
在所有重症急性胰腺炎患者中，40%-70%会出现感染性并发症。感染与死亡率显著升高相关。
方法
我们评估了46例坏死性胰腺炎患者在住院期间接受外科手术时胰腺和全身感染的患病率及特征，以及此类感染性并发症对患者临床结局的影响。在入院时从血液和胆汁中采集微生物培养样本，在侵入性操作2天后从血液、引流液、胆汁和坏死组织中采集样本。
结果
74%的坏死性胰腺炎患者发生了局部或全身感染。入院时，15%的受试者血培养呈阳性，而13%的受试者胆汁培养有细菌生长迹象。在进行清除坏死物质和液体的侵入性操作2天后，尽管使用了抗生素预防，仍有30%的患者血培养呈阳性，22%的病例胆汁培养呈阳性。此外，30%的病例引流液中有细菌生长，44%的病例坏死组织匀浆中有细菌生长。就细菌分离株而言，所有患者均为单一微生物感染。碳青霉烯类药物是敏感性最佳的药物。
结论
感染性并发症显著增加坏死性胰腺炎患者的死亡率。此外，与局部感染患者相比，全身感染患者出现更多并发症且死亡率更高。在我们的研究中，分离出的微生物的敏感性模式表明，对于出现明确全身或局部细菌感染证据的坏死性胰腺炎患者，应将碳青霉烯类药物视为经验性治疗的最佳选择。
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