Digestive Disease Center, Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark.
Department of Health Sciences, Faculty of Medicine, University of Lund, Lund, Sweden.
Eur J Gastroenterol Hepatol. 2020 Oct;32(10):1293-1300. doi: 10.1097/MEG.0000000000001847.
Although the impact of pancreatic infections in acute pancreatitis has been studied extensively, there are no population-based data on extrapancreatic infections and their potential relation to organ failure. We aimed to study the occurrence of pancreatic and extrapancreatic bacterial infections in acute pancreatitis and their relation to patient outcome.
All patients with first-time acute pancreatitis from 2003 to 2012 in a defined area in Sweden were retrospectively evaluated. Data on acute pancreatitis severity, organ failure, infections, and in-hospital mortality were collected.
Overall, 304 bacterial infections occurred in 248/1457 patients (17%). Fifteen percent had extrapancreatic and 2% had pancreatic infections. The lungs (35%), the urinary tract (24%), and the bile ducts (18%) were the most common sites of extrapancreatic infections. Organ failure, severe acute pancreatitis, and in-hospital mortality were more common in patients with vs those without (pancreatic/extrapancreatic) infections (P < 0.05). Organ failure and severe acute pancreatitis occurred more frequently in pancreatic vs extrapancreatic infections (70% vs 34%, P < 0.001 and 67% vs 28%, P < 0.001), but in-hospital mortality did not differ between the two groups (7.4% vs 6.8%, P = 1.0). Both pancreatic and extrapancreatic infections were independent predictors of organ failure (P < 0.05). Out of culture-positive infections, 18% were due to antibiotic-resistant bacteria, without any significant difference between extrapancreatic vs pancreatic infections (P > 0.05). About two out of five infections were of nosocomial origin.
Extrapancreatic infections occurred in 15% and pancreatic infections in 2% of patients with first-time acute pancreatitis. Both pancreatic and extrapancreatic infections were independent predictors of organ failure, leading to increased mortality.
尽管已经广泛研究了胰腺感染对急性胰腺炎的影响，但目前尚缺乏有关胰外感染及其与器官衰竭潜在关系的基于人群的数据。我们旨在研究急性胰腺炎中胰腺和胰外细菌感染的发生情况及其与患者预后的关系。
对瑞典某一特定区域 2003 年至 2012 年首次发生急性胰腺炎的所有患者进行回顾性评估。收集了急性胰腺炎严重程度、器官衰竭、感染和住院死亡率的数据。
总体而言，1457 例患者中有 248 例（17%）发生了 304 例细菌感染。15%的患者有胰外感染，2%的患者有胰腺感染。肺部（35%）、泌尿道（24%）和胆管（18%）是胰外感染最常见的部位。有（胰外/胰腺）感染的患者更易发生器官衰竭、重症急性胰腺炎和住院死亡率（P<0.05）。胰腺感染比胰外感染更常发生器官衰竭（70%比 34%，P<0.001）和重症急性胰腺炎（67%比 28%，P<0.001），但两组的住院死亡率无差异（7.4%比 6.8%，P=1.0）。胰腺和胰外感染均是器官衰竭的独立预测因子（P<0.05）。在培养阳性感染中，有 18%是由抗生素耐药菌引起的，胰外感染和胰腺感染之间无显著差异（P>0.05）。大约五分之二的感染是医院获得性的。
首次发生急性胰腺炎的患者中，15%有胰外感染，2%有胰腺感染。胰腺和胰外感染均是器官衰竭的独立预测因子，导致死亡率增加。
