摘要/Abstract

摘要： 目的 ·分析中度重症急性胰腺炎（ moderately severe acute pancreatitis，MSAP）和重症急性胰腺炎（ severe acute pancreatitis， SAP）继发胰腺 /胰周革兰阴性耐药菌感染的来源、菌种特点及其对病程和预后的影响。方法 ·回顾 2013—2017年上海交通大学医学院附属瑞金医院急诊科、胰腺外科与重症医学科收治的符合研究条件的患者，筛选胰腺 /胰周革兰阴性菌（ Gram-negative bacteria， GNB）感染的患者，并分为多重耐药（ multiple drug resistant，MDR）革兰阴性菌 (MDR-GNB)组和非多重耐药革兰阴性菌（ non-MDRGNB）组，对比分析基础临床信息、耐药菌的来源、耐药菌感染对病情进展及预后的影响。结果 ·共收治 197例 MSAP和 SAP患者，胰腺 /胰周标本明确 GNB感染 92例 (46.70%)，其中 MDR-GNB感染患者 61例（占 66.30%），non-MDR-GNB感染患者 31例（占 33.70%）；胰腺 /胰周标本共检出 117株 GNB，其中 MDR-GNB 69株，主要是多重耐药肺炎克雷伯杆菌（ Klebsiella pneumoniae，KP）（MDR-KP）（39株，56.52%）和多重耐药鲍曼不动杆菌（ Acinetobacter baumannii，AB）（MDR-AB）（22株，31.88%）；MDR-GNB组经皮穿刺置管引流（ percutaneous catheter drainage，PCD）继发耐药菌感染的发生率显著高于 non-MDR-GNB组（36.07% vs 12.90%， P0.020）；耐药菌感染可导致机械通气时间延长 [（17.65±11.74）d vs（9.67±9.34）d，P0.001]、碳青霉烯类和特殊抗菌药物使用增加（P0.000）、首次开腹手术时间提前（[ 21.92±11.45）d vs（29.36±21.48）d，P0.032]、≥ 2次开腹手术发生率增高（ 45.90% vs 22.58%， P0.029）、总住院时间延长（ 54.44±42.38）d vs（32.51±27.62）d，P0.011）和病死率增高（ 34.43% vs 12.90%，P0.028）；死亡患者中 MDR-KP的感染率显著高于存活患者（ 85.71% vs 52.50%，P0.000），而其他耐药菌在 2组中差异均无统计学意义。结论 · MSAP和 SAP继发胰腺 /胰周革兰阴性耐药菌感染的患者中， MDR-KP和 MDR-AB占据了主导地位。耐药菌感染的来源中， PCD继发感染的发生率最高。耐药菌感染可导致病程延长、用药和手术增加及预后不良，其中 MDR-KP的感染更是与预后不良直接相关。
关键词: 急性胰腺炎, 多重耐药, 革兰阴性菌, 预后
Abstract:
Objective · To analyze the bacterial origin and characteristics, and their influence on the process and prognosis in moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) patients with pancreatic/peri-pancreatic infections due to multiple drug resistant (MDR) Gram-negative bacteria (GNB). Methods · Patients of pancreatitis hospitalized in the Departments of Emergency, Pancreatic Surgery and Critical Care Medicine were enrolled in this study. The patients with pancreatic/peri-pancreatic GNB infections were screened and divided into MDR-GNB group and non-MDRGNB group. The basic clinical features, the source of resistant bacteria, the progress of the disease and the prognosis were analyzed and compared within two groups. Results · 92(46.70%) out of 197 MSAP and SAP patients were confirmed as GNB infected, 61 cases (66.30%) with MDR strains and 31 cases (33.70%) with non-MDR strains. 117 GNB were isolated. The main MDR strains were Klebsiella pneumoniae (KP) (39/69) and Acinetobacter Baumannii (AB) (22/69). The incidence of percutaneous catheter drainage (PCD) associated MDR bacterial infections in MDR-GNB group was significantly higher than that of non-MDR-GNB group (36.07% vs 12.90%, P0.020). The MDR-GNB infections could lead to prolonged mechanical ventilation[ (17.65±11.74) d vs (9.67±9.34) d, P0.001], increased of carbapenems and special antibiotics (P0.000), earlier intervention of first laparotomy [(21.92±11.45) d vs (29.36±21.48) d, P0.032], increased incidence of multiple operations (45.90% vs 22.58%, P0.029), prolonged total hospitalization [(54.44±42.38) d vs (32.51±27.62) d, P0.011] and higher mortality (34.43% vs 12.90%, P0.028). The incidence of MDR-KP infections in death patients was significantly higher than that in the surviving patients (85.71% vs 52.50%, P0.000), while the other MDR bacteria did not present statistical difference in the two groups. Conclusion · MDRKP and MDR-AB are the main resistant GNB in MSAP and SAP patients with pancreatic/peri-pancreatic infections. The PCD associated infection is the main source of nosocomial MDR bacterial infections. Infections due to MDR-GNB could lead to prolonged therapy course, increased of antibiotics, augmented operation, and poor outcome. The infection of MDR-KP is directly related to poor outcome.
Key words: acute pancreatitis, multiple drug resistant, Gram-negative bacteria, prognosis


PDF全文下载地址:

点我下载PDF