Luiten E J, Hop W C, Endtz H P, Bruining H A
Department of Surgery, Erasmus Medical Center Rotterdam, The Netherlands.
Intensive Care Med. 1998 May;24(5):438-45. doi: 10.1007/s001340050593.
To establish, firstly, whether gram-negative (re)-colonization of the gut leads to an increased risk of gram-negative pancreatic infections and whether this event is time-related and, secondly, whether the difference in the quantity and quality of micro-organisms colonizing the digestive tract influences morbidity and mortality.
Prospective analysis of the results of systematic semi-quantitative cultures of several body areas taken from patients with severe acute pancreatitis, during a controlled multicenter trial of adjuvant selective decontamination.
Surgical intensive care units of 16 hospitals.
A total of 2,159 semi-quantitative cultures from the oropharynx, rectum and pancreatic tissues taken from 90 patients were analyzed.
Surveillance cultures from the oropharynx and rectum were taken on admission and repeated twice weekly and from the (peri)-pancreatic devitalized tissues (i. e. necrosis) at every relaparotomy and from drainage.
All gram-negative pancreatic infections were preceded by intestinal colonization with the same micro-organisms. The risk of developing a pancreatic infection following gram-negative intestinal colonization (15/42 patients) was significantly higher as compared to patients without gram-negative colonization (0/10 patients) (p < 0.001) or to patients in whom E. coli was the only intestinal micro-organism cultured (0/30 patients) (p < 0.001). The occurrence of intestinal E. coli did not increase the risk of pancreatic infection. Gram-negative colonization of the rectum and oropharynx significantly correlated with the later development of pancreatic infection: relative risks 73.7 (p < 0.001) and 13.6 (p < 0.001), respectively. However, when both areas were evaluated simultaneously, the rectum was more significant (p < 0.001). The severity of intestinal intestinal colonization until the moment of pancreatic infection showed an increase in time in all 15 patients. In 11 of 15 patients (73%) these infections occurred within 1 week following the first isolation from the digestive tract. Gram-negative intestinal colonization was associated with a 3.7 fold increased mortality risk (p = 0.004).
Gram-negative intestinal colonization, E. coli excepted, is an early prognostic parameter in patients in whom pancreatic infection has not yet occurred and represents a significantly increased risk of pancreatic infections and mortality.
首先确定肠道革兰氏阴性菌再定植是否会增加革兰氏阴性菌胰腺感染的风险，以及这一事件是否与时间相关；其次确定定植于消化道的微生物在数量和质量上的差异是否会影响发病率和死亡率。
在一项辅助性选择性去污的对照多中心试验中，对重症急性胰腺炎患者多个身体部位的系统半定量培养结果进行前瞻性分析。
16家医院的外科重症监护病房。
分析了从90例患者的口咽、直肠和胰腺组织采集的总共2159份半定量培养样本。
入院时采集口咽和直肠的监测培养样本，每周重复两次；每次再次剖腹手术时从（胰）胰腺失活组织（即坏死组织）以及引流液中采集样本。
所有革兰氏阴性菌胰腺感染之前均有相同微生物在肠道定植。革兰氏阴性菌肠道定植后发生胰腺感染的风险（42例患者中有15例）显著高于未发生革兰氏阴性菌定植的患者（10例患者中有0例）（p<0.001），也高于仅培养出大肠杆菌作为肠道微生物的患者（30例患者中有0例）（p<0.001）。肠道大肠杆菌的出现并未增加胰腺感染的风险。直肠和口咽的革兰氏阴性菌定植与胰腺感染的后期发生显著相关：相对风险分别为73.7（p<0.001）和13.6（p<0.001）。然而，同时评估这两个部位时，直肠的相关性更强（p<0.001）。在所有15例患者中，直至胰腺感染时肠道定植的严重程度随时间增加。15例患者中有11例（73%）在首次从消化道分离出微生物后的1周内发生了这些感染。革兰氏阴性菌肠道定植与死亡风险增加3.7倍相关（p = 0.004）。
除大肠杆菌外，革兰氏阴性菌肠道定植是尚未发生胰腺感染患者的早期预后参数，且代表胰腺感染和死亡风险显著增加。
