多重耐药铜绿假单胞菌感染对急性胰腺炎患者的影响。
The impact of multi-drug resistant Pseudomonas aeruginosa infections on acute pancreatitis patients.
机构信息
Department of Gastroenterology, Xiangya Hospital, Central South University, Xiangya Road, Changsha, 410008, Changsha, China.
Department of Emergency, Third Xiangya Hospital, Central South University, Changsha, China.
出版信息
BMC Infect Dis. 2023 May 22;23(1):340. doi: 10.1186/s12879-023-08230-y.
INTRODUCTION
Acute pancreatitis (AP) accounts for a high proportion of digestive diseases worldwide and has a high risk of infection. Pseudomonas aeruginosa, a common pathogen of hospital infections, has been observed to increase the resistance rate to several antibiotics, causing difficulties in treatments. Our study aims to investigate the impact of the multi-drug resistant Pseudomonas aeruginosa (MDR-PA) infections on AP patients.
METHODS
At two Chinese tertiary referral centers for AP patients infected with MDR-PA, a retrospective case-control study with a 1:2 case-control ratio was performed. Comparisons were preformed between with/without MDR-PA infections and different drug-resistance of MDR-PA infections patients, respectively. Independent risk factors of overall mortality were assessed via univariate and multivariate binary logistic regression analyses, and the distribution and antibiotic resistant rates of strains were described.
RESULTS
Mortality in AP patients with MDR-PA infections was significantly higher than in those without MDR-PA infections (7 (30.4%) vs. 4 (8.7%), P = 0.048). The rate of prophylactic use of carbapenem for 3 days (0 vs. 50%, P = 0.019) and the incidence rate of multiple organ failure (MOF) (0 vs. 57.1%, P = 0.018) were remarkably higher in the carbapenem-resistant Pseudomonas aeruginosa group compared with the carbapenem-sensitive Pseudomonas aeruginosa group. In the multivariate analysis, the severe categories of AP (OR = 13.624, 95% CIs = 1.567-118.491, P = 0.018) and MDR-PA infections (OR = 4.788, 95% CIs = 1.107-20.709, P = 0.036) were independent risk factors for mortality. The resistance rates of MDR-PA strains were low for amikacin (7.4%), tobramycin (3.7%), and gentamicin (18.5%). The resistance rates of MDR-PA strains to imipenem and meropenem were up to, 51.9% and 55.6%, respectively.
CONCLUSION
In AP patients, severe categories of AP and MDR-PA infections were both independent risk factors for mortality. Inappropriate use of carbapenem antibiotics and MOF were related to carbapenem-resistant Pseudomonas aeruginosa infections. Amikacin, tobramycin, and gentamicin are recommended for the treatment of AP patients with MDR-PA infections.
简介
急性胰腺炎（AP）占全球消化疾病的很大比例，具有很高的感染风险。铜绿假单胞菌是医院感染的常见病原体，已观察到其对几种抗生素的耐药率增加，导致治疗困难。我们的研究旨在探讨多重耐药铜绿假单胞菌（MDR-PA）感染对 AP 患者的影响。
方法
在两家中国 AP 患者 MDR-PA 感染的三级转诊中心，进行了回顾性病例对照研究，病例对照比为 1:2。分别比较了有/无 MDR-PA 感染和不同 MDR-PA 感染患者的药物耐药性。通过单因素和多因素二元逻辑回归分析评估总死亡率的独立危险因素，并描述菌株的分布和抗生素耐药率。
结果
MDR-PA 感染的 AP 患者死亡率明显高于无 MDR-PA 感染的患者（7（30.4%）vs. 4（8.7%），P=0.048）。碳青霉烯类药物预防使用 3 天的比例（0% vs. 50%，P=0.019）和多器官功能衰竭（MOF）发生率（0% vs. 57.1%，P=0.018）在碳青霉烯类耐药铜绿假单胞菌组显著高于碳青霉烯类敏感铜绿假单胞菌组。在多因素分析中，AP 的严重程度（OR=13.624，95%CI=1.567-118.491，P=0.018）和 MDR-PA 感染（OR=4.788，95%CI=1.107-20.709，P=0.036）是死亡率的独立危险因素。MDR-PA 菌株对阿米卡星（7.4%）、妥布霉素（3.7%）和庆大霉素（18.5%）的耐药率较低。MDR-PA 菌株对亚胺培南和美罗培南的耐药率分别高达 51.9%和 55.6%。
结论
在 AP 患者中，AP 的严重程度和 MDR-PA 感染均为死亡率的独立危险因素。碳青霉烯类抗生素的不当使用和 MOF 与碳青霉烯类耐药铜绿假单胞菌感染有关。建议使用阿米卡星、妥布霉素和庆大霉素治疗 MDR-PA 感染的 AP 患者。
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