Cheng Guilan, Wang Dingxi, Zhu Ping, Lin Ziqi, Zhu Shichao, Li Juan, Li Linqian, Zhang Yipeng, Li Guixiang
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, People's Republic of China.
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Infect Drug Resist. 2022 Mar 31;15:1439-1447. doi: 10.2147/IDR.S354347. eCollection 2022.
There are few published reports describing the clinical characteristics of acute pancreatitis (AP) patients with multidrug-resistant organism (MDRO) infection.
This was a retrospective analysis of AP patients with MDRO infection in West China Hospital between July 2015 and June 2020. Basic clinical data, disease progression states, and prognoses of the MDRO and non-MDRO infection groups were compared and analyzed. Logistic regression analysis was performed to explore the related risk factors for MDRO infection. The prognoses of different MDRO infection types were compared.
In total, 9812 AP patients were included, 2436 (24.83%) of whom had healthcare-associated infections (641 [26.31%] MDRO infections and 1795 [73.69%] non-MDRO infections). The main MDRO strain was carbapenem-resistant (CRAB) (400/62.40%). The rate of discharge against doctor's advice, mortality, hospitalization expenses, and hospitalization days was higher in the MDRO infection group than in the noninfection group. By logistic regression analysis, the independent risk factors associated with MDRO infection included male sex (OR 1.36, 95% CI 1.091.70), severity (OR 1.40, 95% CI 1.101.78), ICU referral (OR 2.48, 95% CI 1.793.44), abdominal puncture (OR 2.78, 95% CI 1.934.02), fiberoptic bronchoscopy (OR 1.95, CI 1.352.81), and PICC/CVC placement (OR 1.48, CI 1.062.06). Compared with biliary and hypertriglyceridemia (HTG) (OR 0.94, 95% CI 0.731.23), alcohol (OR 0.30, 95% CI 0.190.47) and other etiologies (OR 0.58, 95% CI 0.41~0.81) conferred a lower risk of MDRO infection. The carbapenem-resistant (CRKP) infection rate was highest in the patients who died.
The CRAB proportion was highest in AP patients with MDRO infection. MDRO infection is related to many factors, has a poor prognosis, and increases the patient burden. CRKP infection is directly related to poor prognosis.
很少有已发表的报告描述多重耐药菌（MDRO）感染的急性胰腺炎（AP）患者的临床特征。
这是一项对2015年7月至2020年6月期间在华西医院发生MDRO感染的AP患者的回顾性分析。比较并分析了MDRO感染组和非MDRO感染组的基本临床数据、疾病进展状态和预后。进行逻辑回归分析以探索MDRO感染的相关危险因素。比较了不同MDRO感染类型的预后。
共纳入9812例AP患者，其中2436例（24.83%）发生了医疗相关感染（641例[26.31%]为MDRO感染，1795例[73.69%]为非MDRO感染）。主要的MDRO菌株是耐碳青霉烯类鲍曼不动杆菌（CRAB）（400/62.40%）。MDRO感染组的自动出院率、死亡率、住院费用和住院天数均高于非感染组。通过逻辑回归分析，与MDRO感染相关的独立危险因素包括男性（OR 1.36，95%CI 1.091.70）、病情严重程度（OR 1.40，95%CI 1.101.78）、转入重症监护病房（ICU）（OR 2.48，95%CI 1.793.44）、腹腔穿刺（OR 2.78，95%CI 1.934.02）、纤维支气管镜检查（OR 1.95，CI 1.352.81）以及经外周静脉中心静脉置管（PICC/CVC）（OR 1.48，CI 1.062.06）。与胆源性和高甘油三酯血症（HTG）（OR 0.94，95%CI 0.731.23）相比，酒精性（OR 0.30，95%CI 0.190.47）和其他病因（OR 0.58，95%CI 0.41~0.81）导致MDRO感染的风险较低。耐碳青霉烯类肺炎克雷伯菌（CRKP）感染率在死亡患者中最高。
MDRO感染的AP患者中CRAB所占比例最高。MDRO感染与多种因素相关，预后较差，并增加了患者负担。CRKP感染与预后不良直接相关。
