急性胰腺炎患者感染的临床特征、耐药性及死亡危险因素：一项来自中国的单中心回顾性研究
Clinical Characteristics, Drug Resistance, and Risk Factors for Death of Infection in Patients with Acute Pancreatitis: A Single-Center Retrospective Study from China.
作者信息
Jia Yan, Liu Ya, Huang Yilin, Wang Jie, Wang Hanyue, Tan Shu, Shi Yuxin, Wang Qingxia, Peng Jie
机构信息
Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Emergency, Loudi Central Hospital, Loudi, Hunan, People's Republic of China.
出版信息
Infect Drug Resist. 2023 Aug 7;16:5039-5053. doi: 10.2147/IDR.S410397. eCollection 2023.
OBJECTIVE
Infection is a common complication of acute pancreatitis (AP). (KP) is one of the most common pathogens associated with nosocomial infections. Our study focuses on investigating the clinical characteristics and risk factors for death of infections in AP patients, further to quantify the prognosis of the patients, and provide evidence for guiding antibiotic use and improving prognosis.
METHODS
The data of epidemiology, clinical manifestations and drug resistance rate with infections in AP patients from January 1, 2012 to August 30, 2022 were retrospectively collected. Logistic regression model and Cox regression model were, respectively, used to determine the risk factors for carbapenem-resistant (CRKP) acquisition and death. The nomogram prediction model was built by RMS software package to predict the 90-day survival rate.
RESULTS
One hundred and twenty-six AP patients combined with infections, with a mortality rate of 34.9%. The most common infection sites were pancreas and peri-pancreas (54.8%), followed by lung (20.6%) and blood stream (18.3%). The resistance rate of to commonly used antibiotics in clinical practice was high, especially CRKP, which was only sensitive to sulfamethoxazole-trimethoprim (SMZ-TMP) and tigecycline (TGC) (resistance rates were 37.57% and 17.57%, respectively). Independent risk factors for CPKP acquisition were male (OR = 1.655, 95% CI 0.642-4.265, P = 0.017) and PICC/CVC implantation (OR = 3.157, 95% CI 1.223-8.147, P = 0.021). Independent risk factors for mortality included carbapenem resistance (HR = 2.556, 95% CI 1.011-6.462, P = 0.047), hemorrhage (HR = 2.392, 95% CI 1.104-5.182, P = 0.027), septic shock (HR = 3.022, 95% CI 1.312-6.959, P = 0.009), age >60 years (HR = 2.977, 95% CI 1.303-6.799, P = 0.01), creatinine >177μmol/L (HR = 2.815, 95% CI 1.075-7.369, P = 0.035).
CONCLUSION
infection has become a serious threat for AP patients, which recommends us more attention and active new strategies seeking.
目的
感染是急性胰腺炎（AP）的常见并发症。肺炎克雷伯菌（KP）是医院感染最常见的病原体之一。本研究旨在调查AP患者感染的临床特征和死亡危险因素，进一步量化患者预后，为指导抗生素使用和改善预后提供依据。
方法
回顾性收集2012年1月1日至2022年8月30日AP患者感染的流行病学、临床表现及耐药率数据。分别采用Logistic回归模型和Cox回归模型确定耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的危险因素及死亡危险因素。采用RMS软件包构建列线图预测模型，预测90天生存率。
结果
126例AP合并感染患者，死亡率为34.9%。最常见的感染部位是胰腺及胰周（54.8%），其次是肺部（20.6%）和血流（18.3%）。肺炎克雷伯菌对临床常用抗生素的耐药率较高，尤其是CRKP，仅对复方磺胺甲恶唑（SMZ-TMP）和替加环素（TGC）敏感（耐药率分别为37.57%和17.57%）。CRKP感染的独立危险因素为男性（OR = 1.655，95%CI 0.642 - 4.265，P = 0.017）和PICC/CVC置管（OR = 3.157，95%CI 1.223 - 8.147，P = 0.021）。死亡的独立危险因素包括碳青霉烯类耐药（HR = 2.556，95%CI 1.011 - 6.462，P = 0.047）、出血（HR = 2.392，95%CI 1.104 - 5.182，P = 0.027）、感染性休克（HR = 3.022，95%CI 1.312 - 6.959，P = 0.009）、年龄>60岁（HR = 2.977，95%CI 1.303 - 6.799，P = 0.01）、肌酐>177μmol/L（HR = 2.815，95%CI 1.075 - 7.369，P = 0.035）。
结论
感染已成为AP患者的严重威胁，建议我们给予更多关注并积极寻求新策略。
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