Li Fang, Zhang Feng, Wan Xueqin, Wu Kesong, Liu Qing, Qiu Chuiyan, Yin Haiyan, Lyu Jun
Department of Intensive Care Unit, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China.
Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Dig Dis Sci. 2023 Feb;68(2):630-643. doi: 10.1007/s10620-022-07793-1. Epub 2022 Dec 23.
Acute pancreatitis (AP) is a common gastrointestinal disease in which infection is a serious complication. Understanding its bacterial spectrum and antibiotic resistance is of great significance for treatment.
This retrospective study analyzed the Medical Information Mart for Intensive Care database with the aim of identifying the distribution characteristics of pathogenic bacteria in AP patients.
First, 2089 AP patients were classified and analyzed statistically according to culture results. Second, the bacterial profile, antibiotic resistance, and antibiotic-use data of positive culture group were analyzed. Third, logistic regression analysis was used to identify the rick factors of culture results, and culture results correlations with mortality.
This study included 1486 patients in negative culture group, 603 patients in positive cultures. Enterococcus spp. (71%), Enterococcus faecium (61%), and Staphylococcus aureus coagulase-positive (54%) exhibited the highest proportions of drug resistance. Logistic regression revealed five factors related to positive culture (the number of antibiotics, length of stay in hospital, length of stay in intensive care unit, mechanical ventilation, and parenteral nutrition) and four factors related to distribution of multidrug-resistant bacterial infection (age, hemoglobin, length of stay in hospital, and duration on antibiotics).
This study found that enteric bacteria were the most common source of infection (26.7%). Carbapenems, penicillins containing enzyme inhibitors, fifth-generation cephalosporins, oxazolidinones, and some of the aminoglycoside antibiotics had high sensitivity, which can guide the use of clinical empiric antibiotics. Positive culture was an independent risk factor for in-hospital all-cause mortality of AP patients.
急性胰腺炎（AP）是一种常见的胃肠道疾病，感染是其严重并发症。了解其细菌谱和抗生素耐药性对治疗具有重要意义。
本回顾性研究分析重症监护医学信息数据库，旨在确定AP患者病原菌的分布特征。
首先，根据培养结果对2089例AP患者进行分类并统计分析。其次，分析阳性培养组的细菌谱、抗生素耐药性及抗生素使用数据。第三，采用逻辑回归分析确定培养结果的危险因素以及培养结果与死亡率的相关性。
本研究纳入阴性培养组患者1486例，阳性培养组患者603例。粪肠球菌（71%）、屎肠球菌（61%）和凝固酶阳性金黄色葡萄球菌（54%）的耐药比例最高。逻辑回归显示与阳性培养相关的五个因素（抗生素使用数量、住院时间、重症监护病房住院时间、机械通气和肠外营养）以及与多重耐药菌感染分布相关的四个因素（年龄、血红蛋白、住院时间和抗生素使用时长）。
本研究发现肠道细菌是最常见的感染源（26.7%）。碳青霉烯类、含酶抑制剂的青霉素类、第五代头孢菌素类、恶唑烷酮类以及部分氨基糖苷类抗生素具有较高敏感性，可指导临床经验性抗生素的使用。阳性培养是AP患者院内全因死亡的独立危险因素。
